How to use high-sensitivity cardiac troponins in acute cardiac care.

High-sensitivity troponin assays, when used and viewed in the clinical context, provide a definite diagnostic benefit compared to conventional troponin assays, especially due to the improved early rule-out of acute myocardial infarction in troponin-negative patients. The interpretation of positive troponin results and, thus, the rule-in of acute myocardial infarction have become more challenging. High sensitivity Tn assays can detect very small but prognostically significant troponin increases, but the underlying diagnoses are diverse. Especially patients with non-ACS-related troponin elevations have an adverse outcome and require careful patient management. Additionally, the interpretation of a significant rise or fall of troponin values has not been standardized yet. Despite these challenges, troponin is a unique marker, which allows for the specific detection of myocardial cell necrosis and the new high sensitivity assays are a great chance to identify more patients at risk and improve their management and care.

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