Better, higher, lower, faster: increasingly rapid clinical decision making using high-sensitivity cardiac troponin assays

Noreen van der Linden, Alexander S. Streng, Will K. W. H. Wodzig, Otto Bekers, Steven J. R. Meex


The diagnosis of acute myocardial infraction has undergone a noticeable transformation since the introduction of the high-sensitivity cardiac troponin assays. The clear shift towards increasingly rapid clinical decision making is reflected in the most recent European Society of Cardiology guidelines, which include a 0-/1-hour algorithm for the diagnosis of non-ST-elevation myocardial infarction. The use of this algorithm enables rule-in or rule-out in approximately 70–75% of all patients after a second cardiac troponin measurement after one hour. In a minority of patients rule-in or rule-out is achievable even faster; after only a single blood draw at presentation. Since rapid clinical decision making has several advantages, like fast initiation of treatment for those who need it and preventing prolonged patient anxiety, various recent studies have tried to further optimize these cut-off values at presentation.