Will new higher-precision troponins lead to clarity or confusion?

Troponins are a cornerstone for the diagnosis of myocardial infarction, assessment of risk and prognosis, and determination of antithrombotic and a revascularization strategy in patients with acute coronary syndromes. Newer assays with higher precision for detection of troponin levels are about to enter clinical practice. The present review discusses the implications of the new assays for patients.

Several studies have found that higher-precision troponin assays can determine prognosis at lower cutpoints than currently used in patients with acute coronary syndromes and that about a third of patients 6 months after admission have detectable low levels of troponins. Elevation of troponins can also be detected with the new assays at about 2 h after the onset of ischemic symptoms. This could result in earlier triage to an invasive strategy, and the findings of a repeat normal level at an earlier time point than currently recommended could lead to earlier discharge from the emergency department and cost savings. Elevated high-precision troponin levels have also been found in the community and in patients with heart failure.

The new high-precision assays will enable better determination of risk and new paradigms will be developed about detection of elevated troponin levels in patients with chronic stable angina and the normal population. Patients with acute coronary syndromes will be able to be triaged earlier and patient care will be improved.