ECS 2020 Recommendations for hs-cTn
In patients with suspected NSTE-ACS, the measurement of hs-cTn as a marker of cardiomyocyte injury is mandatory.1
Advantages of hs-cTn Assays Over Conventional Assays
Compared to conventional assays, hs-cTn assays are associated with the advantages below:1
Higher sensitivity for detection of MI at presentation
Higher negative predictive value for AMI
Shorter interval between 2 cTn measurements
Can detect patients whose cTn was undetectable using conventional assays
Value of High-Sensitive Cardiac Troponin2
Early detection of MI
Enables more rapid “rule-in” and “rule-out” of MI
Increase detection of type 1 MI and type II MI
Decrease diagnosis of unstable angina
Higher accuracy at the exact low cost
A Quantitative Marker for Cardiomyocyte Damage
hs-cTn assays can detect cardiac troponin in a significant portion of healthy population.1
Apart from MI, there are several other conditions that can be associated with increased cTn levels.1
Conditions Other Than Acute Type 1 MI Associated with Myocardial Injury Causing cTn Elevations1
Tachyarrhythmias, heart failure, hypertensive emergencies, critical illness, myocarditis, Takotsubo syndrome, valvular heart disease, aortic dissection and pulmonary embolism
In elderly patients with renal dysfunction, chronic coronary syndromes or hypertensive heart disease are the most frequent causes of elevated cardiac troponin concentration
Assessing the rise and/or fall of cTn levels can help differentiate MI from other conditions associated with cardiomyocyte injury1,3
High Throughput Laboratory Assays vs. POCT
Cardiac troponin assays that are run on automated platforms are mostly sensitive or high-sensitivity assays.1
Most of the POCTs in current use are not considered sensitive or high-sensitivity assays.
Automated assays are preferred.1
ESC 2020 does not recommend the use of biomarkers such as CK, CK-MB, h-FABP, or copeptin, in addition to hs-cTn.1
