Document Detail


Sensitive troponin assays.
MedLine Citation:
PMID:  21705375     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Sensitive troponin assays have been developed to meet the diagnostic goals set by the universal definition of myocardial infarction (MI). The analytical advantages of sensitive troponin assays include improved analytical imprecision at concentrations below the 99th percentile and the ability to define a reference distribution fully. Clinically, the improved sensitivity translates into the ability to diagnosis MI earlier, possibly within 3 h from admission and the ability to use the rate of change of troponin (Δ troponin) for diagnosis. Very sensitive assays may, in appropriately selected populations (perhaps with the addition of Δ troponin), allow diagnosis on hospital admission or within 1-2 h of admission. An elevated troponin level occurring in patients without suspected acute coronary syndromes has, in all studies to date in which outcome has been examined, been shown to indicate an adverse prognosis whatever the underlying clinical diagnosis. Failure of elevation means a good prognosis allowing early, safe hospital discharge, whereas a raised value requires investigation and should help prevent clinically significant pathology being overlooked. Sensitive troponins do present a challenge to the laboratory and the clinician. For the laboratory, the diagnosis of MI requires a change in troponin value. For the clinician, the challenge is to shift from a simplistic yes/no diagnosis of MI based on a single troponin value to a diagnosis that utilises early troponin changes as part of the clinical picture, and to relate the new class of detectable troponin elevation in patients with ischaemic myocardial disease to existing clinical guidelines and trial evidence.
Authors:
Paul O Collinson
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Publication Detail:
Type:  Journal Article; Review     Date:  2011-06-24
Journal Detail:
Title:  Journal of clinical pathology     Volume:  64     ISSN:  1472-4146     ISO Abbreviation:  J. Clin. Pathol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-28     Completed Date:  2011-11-14     Revised Date:  2012-06-27    
Medline Journal Info:
Nlm Unique ID:  0376601     Medline TA:  J Clin Pathol     Country:  England    
Other Details:
Languages:  eng     Pagination:  845-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, St George's Hospital and Medical School, London, UK. paul.collinson@stgeorges.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
Diagnostic Techniques, Cardiovascular* / standards
Early Diagnosis
Humans
Myocardial Infarction / blood,  diagnosis*
Myocardium / metabolism*
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Reproducibility of Results
Sensitivity and Specificity
Time Factors
Troponin / blood*
Up-Regulation
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin
Comments/Corrections
Republished in:
Postgrad Med J. 2012 Jun;88(1040):348-52   [PMID:  22586149 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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