High Sensitivity Troponin: A Blessing in Disguise?

The Universal Definition of Acute Myocardial Infarction changed in 2000 making biomarkers, particularly Troponin, central with a recommended cut off of the 99th percentile of a normal population. However, Troponin assays available at the time, could not measure that level reliably i.e. with a coefficient of variation of less than 10%. This was the driver for manufacturers to develop more sensitive assays. Troponin assays with improved analytical sensitivity, enable clinicians to diagnose or exclude myocardial infarction more quickly. However, this higher sensitivity means that marginally elevated Troponin values are detectable in patients without MI, which may cause confusion. These clinical dilemmas will be discussed together with the interpretation of hs Troponin assays. hs Troponin also allows measurement of Troponin values within the reference range and definition of separate 99th centile values of men and women. The potential clinical value of this will also be discussed.