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Symptoms suggestive of myocardial infarction (MI) represent one of the most common conditions in patients presenting to the emergency department. For the diagnostic evaluation of these patients, algorithms based on cardiac troponin are recommended by guidelines and used in daily practice worldwide.1 In the past 10 years, substantial improvements of these diagnostic strategies have been achieved. This is mainly based on a higher assay sensitivity, which allows the detection of very low troponin concentrations with a high accuracy.2 Using low cut-off concentrations, rapid strategies for rule out of MI after 3 hour or only 1 hour are feasible, efficient and safe. Even a single baseline rule out using a very low troponin cut-off concentration, measured by a high-sensitivity troponin (hs-Tn) assay, provides a high safety to rule out MI.3–6 Currently, up to 20 different troponin assays are commercially available.2 This adds substantially to the confusion around interpretation of the results of the assays. These assays differ in most of their characteristics, such as the limit of detection, the concentration with a 10% coefficient of variation and the sex-specific 99th percentile. This makes interassay comparisons nearly impossible. Hence, findings from diagnostic studies are always specific for the investigated troponin assay and specific informations as cut-offs cannot be transferred to other …
Contributors Both authors contributed to the writing of the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JTN received honoraria from Siemens and Abbott Diagnostics. DW reports speaker fees from Bayer, Boehringer-Ingelheim, Berlin Chemie, Astra Zeneca, Biotronik and Novartis.
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Provenance and peer review Commissioned; internally peer reviewed.
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