New guidance for troponin assays

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1736 (Published 15 March 2012) Cite this as: BMJ 2012;344:e1736
  1. Adam Timmis, professor of clinical cardiology
  1. 1Barts and the London School of Medicine and Dentistry, London Chest Hospital, London E2 9JX, UK
  1. adamtimmis{at}mac.com

Drives down diagnostic thresholds in acute myocardial infarction

The diagnosis of acute myocardial infarction in patients with suspected acute coronary syndromes requires documentation of changing troponin concentrations in the first 24 hours, with at least one value being above the diagnostic threshold.1 Although high sensitivity troponin assays have recently enabled the diagnostic threshold to be reduced, new guidance from the biochemistry group of the Global Task Force for the Universal Definition of Myocardial Infarction raises the prospect of further reductions.2 The guidance recommends that the 99th centile value for plasma troponin is adopted irrespective of assay imprecision, whereas an assay coefficient of variation of 10% or less was mandated previously. In the linked study (doi:10.1136/bmj.e1533), Mills and colleagues examined the potential clinical impact of this new guidance in a cohort of patients with suspected acute coronary syndromes.3

The study’s main finding was that application of the new guidance increased the proportion of patients diagnosed with myocardial infarction. This was a predictable …

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