High-Sensitivity Troponin

Six Lessons and a Reading

James H P Gamble; Edward Carlton; William Orr; Kim Greaves


Br J Cardiol. 2013;20(4) 

In This Article

Abstract and Introduction


New high-sensitivity troponin assays will reduce the threshold for the diagnosis of myocardial infarction (MI), as specified in the 2012 third Universal Definition of MI. They will also allow earlier diagnosis of MI, but serial testing is required for adequate specificity. They convey prognostic information in both MI and in other acute conditions. Interpretation of troponin results must be in combination with a full assessment of the clinical context.

This review discusses these concepts and developments in this area.


Myocardial infarction (MI) remains a common diagnosis and cause of death in the UK, despite sustained improvements in outcomes over more than a decade.[1] Clarity in defining MI is important for both clinical diagnosis and research, but the way in which it is defined may significantly change patterns of diagnosis. The adoption of a troponin standard for the definition of MI in 2000 increased the incidence of MI by approximately 15%,[2] and undoubtedly identified more high-risk patients for whom aggressive management would be beneficial. At the 2012 European Society of Cardiology (ESC) meeting the Universal Definition of MI was updated for the third time in a decade,[3] and a major inclusion was the introduction of high-sensitivity cardiac troponin assays, which are again likely to change the rate of MI diagnosis. This review will discuss these new assays and their considerable potential to influence our practice.