High-sensitivity troponin allows accurate rapid diagnosis and discharge but it is not a substitute for a comprehensive patient evaluation

  • Antonio MartelliniEmail author
  • Carlo di Mario

High-sensitivity cardiac troponin (hscTn) assays are replacing the older generation methods for the detection of acute myocardial injury. The key advantage is the higher sensitivity and diagnostic accuracy of hscTn assays, leading to a more rapid confirmation or exclusion of acute myocardial infarction (AMI). The 2015 European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTE-ACS) recommend the use of a 0 h/3 h algorithm, but 0 h/1 h rule-in and rule-out protocols have also been proposed [1]. The positive predictive value for MI is 75–80%, mainly due to the confounding effects of a few other cardiac conditions (dysrhythmias, heart failure, etc.) and many other non-cardiac diseases associated with increased hscTn (pulmonary embolism, infections, renal dysfunction, etc.). In a busy Accident & Emergency Department (A&E), where time and space come at a premium, but missing a diagnosis...


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The authors certify that they have no affiliation or financial involvement in any organization with a direct financial interest in the subject matter discussed in the manuscript.

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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Structural Interventional CardiologyUniversity Hospital CareggiFlorenceItaly

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