Clinical Use of High-Sensitivity Cardiac Troponin in Patients With Suspected Myocardial Infarction
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High-sensitivity cardiac troponin (hs-cTn) assays have been used clinically by thousands of physicians in many countries throughout the world since their clinical introduction 7 years ago. In the early diagnosis of myocardial infarction (MI), beyond doubt, the most important indication of hs-cTn assays, these simple, inexpensive, and highly reproducible tools complement detailed clinical assessment including chest pain characteristics and the electrocardiogram. Hs-cTn assays for the first time allowed the precise quantification of cardiomyocyte injury around the 99th percentile and thereby substantially increased the accuracy of MI detection from blood obtained at presentation to the emergency department (ED). Higher accuracy at ED presentation enabled the development and extensive validation of early hs-cTn-based diagnostic algorithms, which substantially reduced the time required for the safe rule-out or rule-in of MI. This review summarizes key principles underlying the safe and effective use of hs-cTn in the ED in patients with suspected MI.
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cTnI circulates in the bloodstream with low abundance (typically <50 ng/mL) and in myriad proteoforms.
“cTnI forms the inhibitory subunit of the cTn complex (cTnI–cTnT–TnC; Supplementary Fig. 1) and is released into the bloodstream following cardiac injury23–25 where it circulates with low abundance (typically < 50 ng/mL)26 and in myriad proteoforms (e.g., phosphorylated, acetylated, oxidized, and truncated), making detection and analysis extremely challenging.”
From Nanoproteomics enables proteoform-resolved analysis of low-abundance proteins in human serum (2020) · cites this paper as [26]
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- Authors
- Twerenbold, R., Boeddinghaus, J., Nestelberger, T., Wildi, K., Rubini Gimenez, M., Badertscher, P., & Mueller, C.
- Affiliations
- University of Basel (CH)
- Corresponding author
- Mueller, Christian
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 70
- Issue
- 8
- Pages
- 996-1012
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2749133321
- Cited by
- 255
- References
- 116
- Citations by year
- 2026: 18 · 2025: 18 · 2024: 19 · 2023: 25 · 2022: 25 · 2021: 29 · 2020: 43 · 2019: 39 · 2018: 32 · 2017: 7
- FWCI
- 4.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science Foundation
- Bristol-Myers Squibb
- AstraZeneca
- Alere
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (P300PB-167803/1, 167803)
- Schweizerische Herzstiftung
- Stiftung für Kardiovaskuläre Forschung Basel
- Abbott Diagnostics
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- high-sensitivity troponin, myocardial infarction, emergency department, early diagnosis, diagnostic algorithm, rule-in and rule-out, cardiomyocyte injury, chest pain
- MeSH terms
- Algorithms, Humans, Myocardial Infarction, Biomarkers, Troponin I, Troponin T, Early Diagnosis
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