High sensitivity troponin is a great advance in our ability to diagnose acute coronary syndromes. With high sensitivity troponin, we have the ability to detect acute myocardial infarctions that we simply couldn’t detect previously. Thus, many patients with unstable coronary disease who were previously ‘troponin invisible’ (and were therefore labelled as having unstable angina) will now be identified as having non-ST elevation myocardial infarctions (NSTEMI) thanks to the greater analytical sensitivity of the new assays.
This does come with its own challenges, however. With the increase in true positive results comes an increase in false positive results. The greatest challenge is almost certainly the differentiation of ‘true positive’ acute myocardial infarctions (AMIs) from those with non-coronary troponin elevations and type 2 AMIs.
Far from giving a black and white answer about whether the patient has AMI, hs-troponin puts the thinking back into the diagnosis.
I created this hs-troponin user’s guide presentation to try to explain how we should be using hs-troponin to establish whether our patients do indeed have AMI.
I hope you find it useful…