The Clinical Utility of High-Sensitivity Troponin

The diagnosis of acute myocardial infarction (MI) poses a challenge for clinicians, particularly in the absence of clear ECG evidence.  In 2018, a consensus conference of experts reinforced and extended the definition of MI on the basis of cardiac biomarkers and proposed high sensitivity troponin as the preferred cardiac biomarker. These recommendations were published in an article entitled The Fourth Universal Definition of Myocardial Infarction. This document reinforced previous recommendations that advocated for the use of the troponin medical decision to be the 99th percentile of a normal population with a <10% CV at that level as well as defining the features of high sensitivity troponin. In addition, to this medical decision level, the clinical interpretation and significance of elevated troponin levels are reviewed, including non-ischemic causes suggestive of alternate pathologies. Various strategies regarding the implementation of high sensitivity troponin will also be discussed.