Universal definition

Troponin is like rigor mortis

H I G H S E N S I T I V I T Y T R O P O N I N T R E A D S H I G H E R

SO YOU GET MORE POSITIVES

10ng/L

Standard troponin

HS-troponin T

35ng/L14ng/L

ANSWER: 50%

Your patient with suspected ACS

has a POSITIVE hs-troponin

What’s the probability it’s AMI?

Image by anieto2k on Flickr.comBody et al, JACC 2011; 58:

1332-9

ANSWER: 50%

If your patient with suspected ACS

has a positive troponin, what is the

overall probability that they have

AMI?

Image by anieto2k on Flickr..comBody et al, JACC 2011; 58:

1332-9

Troponin as marker of myocardial injury

The Multiple Causes of Troponin Elevation

YO U O N LY G E T A ' N O R M A L ' T RO P O N I N I F T H E PAT I E NT ' S CO ND I T I O N I S A L S O ' NO R M A L '

14

30

37

28

0.

10.

20.

30.

40.

'Normals' All comers

Tro

po

nin

T (

ng

/L)

99th percentile subgroup

99th% Males Females

C o l l i n s o n e t a l , C l i n C h e m 2 0 1 2 ; 5 8 ( 1 ) : 2 1 9 - 2 5

T H E R E ' S A G O O D R E A S O N W H Y T H E

C U T - O F F I S S O LO W !

B u t . . .

7

39

24

5

21

24

0 10 20 30 40 50

<0.05

0.05-0.19

>0.2

% with death or AMI after a year

Validation Implementation

M i l l s e t a l , J A M A 2 0 11 ; 3 0 5 ( 1 2 ) : 1 2 1 0 - 6