High-sensitivity cardiac troponin testing enables more accurate diagnosis of acute coronary syndrome, allowing repeated testing to be shortened to 1 or 2 hours from conventional 3 and 6 hours.
Does high-sensitivity cardiac troponin testing improve the timely diagnosis and management of acute coronary syndrome compared to conventional testing?
High-sensitivity cardiac troponin testing enables rapid 1- or 2-hour rule-out algorithms for suspected ACS, offering significant organizational and economic benefits over conventional 3- to 6-hour testing.
Very seldom, if ever, a single laboratory test has provided such a paradigm shift in the managed care as cardiac troponin (cTn) testing. More than twenty years of improvements in test design and analytical features have contributed to revolutionize the clinical recommendations and guidelines, and the diagnosis of myocardial infarction (MI) is now highly dependent upon the kinetics of cTn within a suggestive clinical setting. Despite the advent of high-sensitivity cTn (HS-cTn) immunoassays has allowed a more accurate and timely diagnosis as well as a higher prognostic accuracy, the focus is now shifting on the most suitable algorithms and on a comprehensive approach to the clinical management of acute coronary syndrome (ACS). In this article we aim to discuss the implications of HS-cTn testing for ruling out and ruling in ACS. In the latter instance, main improvements are related to ACS diagnosis in women, in whom this pathology is still often underdiagnosed or misdiagnosed. A quick and accurate rule out will also regarded as a great advantage from both an organizational and economic standpoint. The advantages that will stem from this new approach have been recently assessed, and shortening of repeated testing 1 or 2 h from conventional algorithms entailing blood sampling at 3 and 6 h seems attainable. The larger benefits will definitely occur in clinical settings where the actual diagnosis rate of MI among patients with suspect ACS is lower and, consequently, the negative predictive value (NPV) of HS-cTn is the highest.
Galli et al. (Fri,) conducted a review in Acute coronary syndrome. High-sensitivity cardiac troponin (HS-cTn) testing vs. Conventional algorithms was evaluated. High-sensitivity cardiac troponin testing enables more accurate diagnosis of acute coronary syndrome, allowing repeated testing to be shortened to 1 or 2 hours from conventional 3 and 6 hours.