How to Use High-Sensitivity Cardiac Troponins in Acute Cardiac Care

Kristian Thygesen; Johannes Mair; Evangelos Giannitsis; Christian Mueller; Bertil Lindahl; Stefan Blankenberg; Kurt Huber; Mario Plebani; Luigi M. Biasucci; Marco Tubaro; Paul Collinson; Per Venge; Yonathan Hasin; Marcello Galvani; Wolfgang Koenig; Christian Hamm; Joseph S. Alpert; Hugo Katus; and Allan S. Jaffe


Eur Heart J. 2012;33(18):2252-2257. 

In This Article

Abstract and Introduction


Recommendations for the use of cardiac troponin (cTn) measurement in acute cardiac care have recently been published.[1] Subsequently, a high-sensitivity (hs) cTn T assay was introduced into routine clinical practice.[2] This assay, as others, called highly sensitive, permits measurement of cTn concentrations in significant numbers of apparently illness-free individuals. These assays can measure cTn in the single digit range of nanograms per litre (=picograms per millilitre) and some research assays even allow detection of concentrations <1 ng/L.[2–4] Thus, they provide a more precise calculation of the 99th percentile of cTn concentration in reference subjects (the recommended upper reference limit [URL]). These assays measure the URL with a coefficient of variation (CV) <10%.[2–4] The high precision of hs-cTn assays increases their ability to determine small differences in cTn over time. Many assays currently in use have a CV >10% at the 99th percentile URL limiting that ability.[5–7] However, the less precise cTn assays do not cause clinically relevant false-positive diagnosis of acute myocardial infarction (AMI) and a CV <20% at the 99th percentile URL is still considered acceptable.[8]

We believe that hs-cTn assays, if used appropriately, will improve clinical care. We propose criteria for the clinical interpretation of test results based on the limited evidence available at this time.