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Cardiac troponin (cTn) measurement is accepted as the gold standard biomarker for the diagnosis of myocardial infarction (MI). Progressive improvement in assay measurement technology has resulted in the present generation of high-sensitivity cTn (hs-cTn) assays, capable of measuring very low levels in apparently healthy individuals. The use of such assays is currently recommended in the Fourth Universal Definition of MI. The ability to measure very low levels of cTn accurately and precisely (repeat measurements that give the same numerical result) triggered an interest in potentially using more timely strategies to confirm or exclude MI. Sampling intervals moved from a single test at 12 hours to the current recommendation from the European Society of Cardiology (ESC) for the use of an accelerated diagnostic pathway (ADP) based on measurement on admission and at 1, 2 or 3 hours thereafter,1 although the 0/1-hour pathway is preferred. There is an extensive literature on the diagnostic efficiency of these ADPs, including meta-analysis of the individual studies,2 but relatively little on their impact on clinical efficiency and patient safety and few clinical trials. Which ADP should be used remains an area where there is an evidence gap.