Clinical Use of High-sensitivity Cardiac Troponin in Patients With Suspected Myocardial Infarction

Raphael Twerenbold, MD; Jasper Boeddinghaus, MD; Thomas Nestelberger, MD; Karin Wildi, MD; Maria Rubini Gimenez, MD; Patrick Badertscher, MD; Christian Mueller, MD


J Am Coll Cardiol. 2017;70(8):996-1012. 

In This Article


hs-cTn assays improve and accelerate the early management of patients presenting with suspected MI and complement assessment using clinical signs and the ECG. The increased sensitivity reduces the "troponin-blind" interval early after onset of MI and allows to substantially shorten the timing of serial hs-cTn remeasurement. Many factors other than acute myocardial ischemia may cause cardiomyocyte injury and therefore mild hs-cTn elevations. Dynamic changes of hs-cTn during serial sampling help to distinguish ischemic from nonischemic causes of chest pain and mild troponin elevations. To maximally profit from hs-cTn assays in clinical practice, they should best be used embedded in an institutional standard operating procedure of the ED and in conjunction with a rapid triage algorithm enabling rapid and safe rule-out and, depending on which algorithm, also rule-in of MI within a few hours. Such an approach will not only allow an increase in patients' safety as compared with conventional, less sensitive cTn assays, but also substantially reduce duration of stay in the ED and costs. Once a process of ≥24 h, many patients can now have MI rapidly and safely excluded already in the ED.