High-Sensitivity Troponin in the Diagnosis of Acute Coronary Syndrome

Michael T. Partin; Nathan J. Hemerly; Karl T. Clebak

MICHAEL T. PARTIN, MD, NATHAN J. HEMERLY, DO, AND KARL T. CLEBAK, MD, MHA

Am Fam Physician. 2024;110(4):425-427

Author disclosure: No relevant financial relationships.

Test	Indication	Population^*	Cost†
High-sensitivity cardiac troponin assay	Ruling in or out acute coronary syndrome	Patients presenting to an emergency department with cardiac symptoms suggestive of acute coronary syndrome	$390.75

Numerous high-sensitivity cardiac troponin (hs-cTn) assays for acute myocardial infarction (MI) are available.^1,2 These assays differ in their limits of detection, precision, and repeatability.³ The American College of Cardiology and American Heart Association guidelines endorse the 99th percentile upper reference limit for detecting myocardial injury to diagnose acute MI using hs-cTn.⁴ Evidence of myocardial injury with cardiac symptoms, new electrocardiogram changes, loss of viable myocardium per imaging, or evidence of coronary thrombus on angiography meets diagnostic criteria for acute MI.⁵ There is no standard cutoff value for hs-cTn. Abnormal values are based on a reference population for individual assays.

Lazar DR, Lazar FL, Homorodean C, et al. High-sensitivity troponin: a review on characteristics, assessment, and clinical implications. Dis Markers. ;2022:9713326.

Yore M, Sharp A, Wu YL, et al. Emergency department cardiac risk stratification with high-sensitivity vs conventional troponin HEART pathway. JAMA Netw Open. 2023;6(12):e2348351.

Sherwood MW, Newby LK. High-sensitivity troponin assays: evidence, indications, and reasonable use. J Am Heart Assoc. 2014;3(1):e000403.

Sandoval Y, Apple FS, Mahler SA, et al.; International Federation of Clinical Chemistry and Laboratory Medicine Committee on the Clinical Application of Cardiac Biomarkers. High-sensitivity cardiac troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guidelines for the evaluation and diagnosis of acute chest pain. Circulation. 2022;146(7):569-581.

Domienik-Karłowicz J, Kupczyńska K, Michalski B, et al. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J. 2021;28(2):195-201.

Hammerer-Lercher A, Ploner T, Neururer S, et al. High-sensitivity cardiac troponin T compared with standard troponin T testing on emergency department admission: how much does it add in everyday clinical practice?. J Am Heart Assoc. 2013;2(3):e000204.

Chapman AR, Lee KK, McAllister DA, et al. Association of high-sensitivity cardiac troponin I concentration with cardiac outcomes in patients with suspected acute coronary syndrome [published correction appears in JAMA. 2018; 319(11): 1168]. JAMA. 2017;318(19):1913-1924.

Sandoval Y, Nowak R, deFilippi CR, et al. Myocardial infarction risk stratification with a single measurement of high-sensitivity troponin I. J Am Coll Cardiol. 2019;74(3):271-282.

Neumann JT, Twerenbold R, Ojeda F, et al.; COMPASS-MI Study Group. Application of high-sensitivity troponin in suspected myocardial infarction. [published correction appears in N Engl J Med. 2022; 387(18): 1724]. N Engl J Med. 2019;380(26):2529-2540.

McCord J, Hana A, Cook B, et al. The role of cardiac testing with the 0/1-hour high-sensitivity cardiac troponin algorithm evaluating for acute myocardial infarction. Am Heart J. 2021;233:68-77.

Tomaszewski CA, Nestler D, Shah KH, et al.; American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Suspected Non–ST-Elevation Acute Coronary Syndromes. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected non-ST-elevation acute coronary syndromes. Ann Emerg Med. 2018;72(5):e65-e106.

Zachoval CF, Dolscheid-Pommerich R, Graeff I, et al. High-sensitivity troponin T testing: consequences on daily clinical practice and effects on diagnosis of myocardial infarction. J Clin Med. 2020;9(3):775.

Lipinski MJ, Baker NC, Escárcega RO, et al. Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis. Am Heart J. 2015;169(1):6-16.e6.

Ganguli I, Cui J, Thakore N, et al. Downstream cascades of care following high-sensitivity troponin test implementation. J Am Coll Cardiol. 2021;77(25):3171-3179.

Twerenbold R, Jaeger C, Rubini Gimenez M, et al. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction. Eur Heart J. 2016;37(44):3324-3332.

Centers for Medicare and Medicaid Services. 23CLABQ4. Accessed November 17, 2023. https://www.cms.gov/medicare/medicare-fee-service-payment/clinicallabfeesched/clinical-laboratory-fee-schedule-files/23clabq3

Chuang MA, Gnanamanickam ES, Karnon J, et al. Cost effectiveness of a 1-hour high-sensitivity troponin-T protocol: an analysis of the RAPID-TnT trial. Int J Cardiol Heart Vasc. 2021;38:100933.

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