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J Am Coll Cardiol. 2013 Apr 30;61(17):1753-8. doi: 10.1016/j.jacc.2012.09.069. Epub 2013 Feb 6.

Preparing the United States for high-sensitivity cardiac troponin assays.

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Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.


It is only a matter of time before the use of high-sensitivity cardiac troponin assays (hs-cTn) becomes common throughout the United States. In preparation for this inevitability, this article raises a number of important issues regarding these assays that deserve consideration. These include: the need for the adoption of a universal nomenclature; the importance of defining uniform criteria for reference populations; the challenge of discriminating between acute and nonacute causes of hs-cTn elevations, and between type 1 and type 2 acute myocardial infarction (AMI); factors influencing the analytical precision of hs-cTn; ascertaining the optimal duration of the rule-out period for AMI; the need for further evaluation to determine the causes of a positive hs-cTn in non-AMI patients; and the use of hs-cTn to risk-stratify patients with disease conditions other than AMI. This review elaborates on these critical issues as a means of educating clinicians and researchers about them.

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