High-Sensitivity Troponin Assays in Clinical Diagnostics of Acute Coronary Syndrome
Danielle Hof1, Arnold von Eckardstein2
1Unilabs, Dübendorf, Dübendorf, Switzerland.
Insights
Cardiac troponin (cTn) measurements are crucial for diagnosing acute coronary syndrome (ACS). High-sensitivity assays and point-of-care tests offer early detection of acute myocardial infarction (AMI), but require validation.
Area of Science:
- Biochemistry
- Clinical Diagnostics
- Cardiology
Background:
- Cardiac troponins (cTn) are key biomarkers for diagnosing acute coronary syndrome (ACS).
- High-sensitivity (hs) immunoassays enable early detection of elevated cTn levels.
- Point-of-care (POC) cTn assays are increasingly available but need clinical validation.
Purpose of the Study:
- To review the technical aspects of cardiac troponin assays.
- To discuss the diagnostic and prognostic utility of cTn in acute myocardial infarction (AMI).
- To provide an overview of cTn use in both AMI patients and the general population.
Main Methods:
- Literature review of technical aspects and clinical studies on cardiac troponins.
- Analysis of diagnostic algorithms integrating hs-cTn measurements.
- Evaluation of POC cTn assay implementation challenges.
Main Results:
- Hs-cTn assays provide precise measurements for early AMI diagnosis.
- Algorithms using serial hs-cTn measurements aid in ruling in/out AMI.
- Clinical validation is essential for POC cTn assay integration.
Conclusions:
- Cardiac troponins are central to ACS and AMI diagnosis.
- Hs-cTn assays and validated POC tests improve early detection and management.
- Further research is needed for widespread POC test adoption.
Abstract:
Nowadays, measurement of cardiac troponins (cTn) in patient plasma is central for diagnosis of patients with acute coronary syndrome (ACS). High-sensitivity (hs) immunoassays have been developed that can very precisely record slightly elevated and rising plasma concentrations of cTn very early after onset of clinical symptoms. Algorithms integrate measurements of hs-cTn at onset of clinical symptoms of acute myocardial infarction (AMI), and 1 or 3 h after onset, to rule-in and rule-out AMI patients. More and more point-of-care (POC) cTn assays conquer the diagnostic market, but thorough clinical validation studies are required before potential implementation of such POC tests into hospital settings. This review provides an overview of the technical aspects, as well as diagnostic and prognostic use of cardiac troponins in AMI patients and in the healthy population.
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