Do high sensitivity cardiac troponin assays improve patient outcomes?

Cardiac troponins have replaced other blood biomarkers for the diagnosis of myocardial injury. They are widely used to risk stratify patients towards safe early discharge or further investigation of coronary anatomy when clinical and electrocardiographic features are suggestive of acute coronary syndrome.

High sensitivity assays can detect lower concentrations of cardiac troponin than older assays, improving test sensitivity and enabling earlier detection of myocardial injury. In practice, use of high sensitivity assays leads to earlier discharge from emergency departments1 and improved detection of myocardial injury that may require further investigation. Although use of high sensitivity assays is increasing in line with guideline recommendations,23 it remains unknown whether use in emergency departments improves long term clinical outcomes for patients with suspected acute coronary syndrome. The linked paper by Lee and colleagues (doi:10.1136/bmj-2023-075009) addresses this important knowledge gap by reporting a secondary observational analysis of the High-Sensitivity Troponin in the Evaluation of patients with suspected Acute Coronary Syndrome (High-STEACS) clinical trial.4

The original cluster randomised stepped wedged trial design included 48 282 patients presenting to emergency departments at 10 Scottish hospitals with suspected acute coronary syndrome.5 All patients …