Cardiac Troponin Assays

for Earlier Diagnosis of Myocardial Infarctions

ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-segment Elevation

  • The 99th percentile for cTn is the single decision limit for both AMI and risk in patients presenting with symptoms of cardiac ischemia (either cTnI or cTnT can be used)
  • Labs may establish a decision limit for each biomarker based on a normal, healthy population with no evidence of heart disease or use the manufacturer’s established value.
  • Imprecision (CV) at the 99th percentile decision point should be ≤ 10%
  • Small myocardial injury can be detected using sensitive assay or imaging
  • Rising or falling kinetics helps discriminate acute from chronic illness

European Heart Journal (2016) 37, 267-315

IFCC Task Force Recommendations


Supports 99th Percentile

  • 99th percentile cut-off universally endorsed
  • Determined in a healthy population
  • Derived from peer-reviewed literature, or manufacturer
  • Analytical precision should be ≤ 10% CV


Defines High-Sensitivity Troponin

  • High-sensitivity assays (hs-assays) should measure cTn > limit of detection (LoD) in ≥ 50% of the healthy subjects used to determine the 99th percentile
  • Results reported in ng/L or pg/mL instead of µg/L (gives whole number values instead of decimals for easier interpretation)

IFCC Task Force on Clinical Applications of Cardiac Biomarkers (


AHA/ACC Guidelines - Cardiac Troponin Highlights

  • 99th percentile for cardiac troponin is appropriate cutoff for considering myocardial necrosis
  • For contemporary assays, serial cardiac troponin levels should be measured at presentation and 3 to 6 hours after symptom onset in all patients who present with chest pain symptoms. This identifies a rising and/or falling pattern
  • In evaluating serial changes, absolute changes appear to have a significantly higher diagnostic accuracy for AMI than relative changes

Journal of the American College of Cardiology Vol 64 No. 24, 2014


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