High-Sensitivity Cardiac Troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guidelines for the Evaluation and Diagnosis of Acute Chest Pain
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The 2021 American Heart Association/American College of Cardiology/American Society of Echocardiography/American College of Chest Physicians/Society for Academic Emergency Medicine/Society of Cardiovascular Computed Tomography/Society for Cardiovascular Magnetic Resonance guidelines for the evaluation and diagnosis of acute chest pain make important recommendations that include the recognition of high-sensitivity cardiac troponin (hs-cTn) as the preferred biomarker, endorsement of 99th percentile upper reference limits to define myocardial injury, and the use of clinical decision pathways, as well as acknowledgment of the uniqueness of women and other patient subsets. Details on how to integrate hs-cTn into clinical practice are less extensively addressed. Clinicians should be aware of some of the analytical aspects related to hs-cTn assays regarding the limit of detection and the limit of quantitation and how they are used clinically, especially for the single sample strategy to rule out acute myocardial infarction. Likewise, it is important for clinicians to understand issues related to the derivation of the 99th percentile upper reference limit; the value of sex-specific 99th percentile upper reference limits; how to use changing concentrations (deltas) to facilitate diagnosis and risk stratification of patients with suspected acute coronary syndrome, including the differentiation of acute from chronic myocardial injury; and how to best integrate the use of hs-cTn with clinical decision pathways. With the use of hs-cTn, conditions such as type 2 myocardial infarction become more common, whereas others such as unstable angina become less frequent but still occur. Sections relating to these issues are included.
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For laboratory diagnosis of acute myocardial infarction, high-sensitivity cardiac troponin needs to be measured at least twice; AMI is diagnosed if hs-cTn is elevated over the 99th percentile of a healthy reference group in at least one measurement and an increase or decrease is observed between measurements, allowing distinction from chronic conditions such as chronic kidney disease.
“For example, for the laboratory diagnosis of acute myocardial infarction (AMI), high-sensitivity cardiac troponin (hs-cTn) needs to be measured at least twice58. AMI is diagnosed if hs-cTn is elevated over the 99th percentile of a healthy reference group in at least one measurement and an increase or decrease in hs-cTn is observed between measurements. This allows to distinguish AMI-related elev”
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- Authors
- Sandoval, Y., Apple, F. S., Mahler, S. A., Body, R., Collinson, P. O., Jaffe, A. S., & on behalf of the International Federation of Clinical Chemistry and Laboratory Medicine Committee on the Clinical Application of Cardiac Biomarkers
- Affiliations
- Mayo Clinic (US)
- University of Minnesota (US)
- Wake Forest University Health Sciences (US)
- Manchester Metropolitan University (GB)
- St George's, University of London (GB)
- Corresponding author
- Jaffe, Allan S.
- Venue
- Circulation
- Published
- 2022-08-16
- Volume
- 146
- Issue
- 7
- Pages
- 569-581
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W4283778928
- Cited by
- 202
- References
- 89
- Citations by year
- 2026: 49 · 2025: 74 · 2024: 46 · 2023: 32 · 2022: 1
- FWCI
- 7.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- 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 › Surgery › Coronary Interventions and Diagnostics
- Keywords
- high-sensitivity troponin, acute chest pain, myocardial injury, 99th percentile upper reference limit, limit of quantification, acute myocardial infarction, acute coronary syndrome, type 2 myocardial infarction, unstable angina, clinical decision pathway, risk stratification
- MeSH terms
- Angina, Unstable, Chest Pain, Female, Humans, Male, Myocardial Infarction, Biomarkers, Troponin T, Acute Coronary Syndrome
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