High-sensitivity cardiac troponin testing for primary care: analytical assay considerations required before widespread implementation

For over 20 years, cardiac troponins T and I have been used as a biomarker for diagnosis of acute coronary syndromes (ACS) and risk stratification for future adverse cardiac events (1,2). Results of cardiac troponin testing produces higher clinical sensitivity and specificity than testing for the creatine kinase-MB (CK-MB) isoenzyme, and today, is recognized as the preferred marker for use in patients suspected of acute myocardial infarction (3). As with other clinical lab tests, the ones for cardiac troponin have undergone improvements over the years, especially with regards to analytical sensitivity and precision. This is reflected by the fact that using the first generation assay, it was not possible to reliably detect cardiac troponin in healthy subjects.