Dr. Erika Kancler
Background: Acute myocardial infarctions (AMI) are a leading cause of death in the United States. The key to increasing survivability is early recognition to expedite the proper treatment modalities. In conjunction with the clinical presentation and electrocardiograms, the use of cardiac biomarkers is exponentially important in not only recognizing a cardiac event but also determining the extent of injury. Advancement in laboratory technology has led to the development of high-sensitive troponin (hs-troponin) assays which can detect smaller cardiac troponin serum levels compared to conventional troponin assays. This implies that the use of hs-troponin assays is more effective in the early detection and extent of tissue ischemia, increasing the chances of AMI survival.
Objective: The purpose of this review is to determine whether the use of hs-troponin assays have a superior diagnostic value compared to conventional troponin assays in earlier identification or ruling-out AMI in patients who present with chest pain or other AMI symptoms.
Methods: A PubMed search was conducted using the following search terms and filters: high-sensitive troponin, cardiac biomarkers, hs-troponin vs. conventional troponin, articles in the last 10 years, English language, randomized control trials, meta-analysis reviews. Articles were excluded if direct comparison between hs-troponin and conventional was not observed, no full text of the article was available, and low participant numbers.
Conclusion: While their use is not fully adopted in the United States, hs-troponin assays can detect lower concentrations of serum troponin levels at the time of presentation compared to conventional assays, which increases their sensitivity but comes with a reduction in specificity. This is promising in early recognition of tissue ischemia and can lead to earlier detection of an AMI and expedite proper treatment pathways but raises the concern of an increase in AMI over diagnosis that may be factitious. When collected as serial markers, the hs-sensitivity troponins were equal with conventional assays in their sensitivity/specificity, which leads to the determination that they are no more effective in cardiac monitoring compared to conventional testing.
Bodin SR, Ramirez, J. Diagnostic Effectiveness of High-sensitivity Troponins. JMU Scholarly Commons Physician Assistant Capstones. http://commons.lib.jmu.edu/pacapstones/26. Published May 16, 2017
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