• Biomarkers
• Myocardial Infarction

High-sensitivity cardiac troponin (hs-cTn) assays are the only guideline-recommended cardiac biomarker for diagnosis of myocardial infarction.1 Their integration into diagnostic pathways that permit the early rule-out of myocardial infarction has improved the efficiency of healthcare delivery without compromising safety.2 3 However, they have led to an increased detection of myocardial injury (troponin concentration over the 99th centile diagnostic threshold) in patients without myocardial infarction, which can cause diagnostic uncertainty.4 Typically, chronic elevations in cardiac troponin are observed in older patients, those with cardiovascular comorbidity including hypertension, ischaemic heart disease, valvular heart disease and structural heart disease, or those with non-cardiovascular comorbidity such as chronic kidney disease or myopathy (figure 1).

As hs-cTn assays were first introduced into clinical practice over a decade ago, in the majority of healthcare settings with access to electronic care records, the results of previous cardiac troponin concentrations will be available. This may provide an opportunity to understand the context of individual patients’ repeat cardiac troponin concentrations. For example, this might allow a clinician to understand whether a low elevation in cardiac troponin concentration was ‘normal’ or ‘abnormal’ for that individual in the context of their cardiovascular status and comorbidity. This individualised assessment could be informative to guide further investigation and treatment.

Roos and …