It’s Time for a Change to a Troponin Standard

Abstract

ecently, the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) convened a conference to discuss refinements in the diagnosis of acute myocardial infarction.The panel on biochemistry considered issues related to the use of marker proteins.We were guided predominantly by the science of the area.We were also cognizant of the impact that changes in the standards would have on epidemiology, clinical trials, education of physicians, and patient care.Our recommendations will be incorporated, with the recommendations of the other panels, into a position paper for the ESC and the ACC.However, the members of the biochemistry group decided to express the opinions we felt were important in this area independently.Our thinking does not represent the position of the ESC, the ACC, or of the conjoint task force.Many modifications of the original World Health Organization criteria for acute myocardial infarction 1 have been accepted and incorporated into the ESC/ACC criteria; some deletions have also occurred.Until recently, most markers were detected using enzymatic activity; detection of the protein concentration now is preferred.Thus, it is more appropriate to refer to molecules released into the circulation as a consequence of cardiac injury as biochemical diagnostic markers or biomarkers.In this editorial, we emphasize issues related to the biochemical diagnosis of acute myocardial infarction.New and improved plasma biomarkers (troponins) with better sensitivity and specificity will be emphasized in preference to markers such as total creatine kinase (CK), CK-MB, lactate dehydrogenase, and aspartate aminotransferase.Rapid assays for the early detection of infarction that may be helpful will be delineated, and the use of the troponin markers to aid in the risk stratification of patients with acute coronary syndromes will be recommended.