ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-segment Elevation
- The 99th percentile for cTn is the single decision limit for both AMI and risk in patients presenting with symptoms of cardiac ischemia (either cTnI or cTnT can be used)
- Labs may establish a decision limit for each biomarker based on a normal, healthy population with no evidence of heart disease or use the manufacturer’s established value.
- Imprecision (CV) at the 99th percentile decision point should be ≤ 10%
- Small myocardial injury can be detected using sensitive assay or imaging
- Rising or falling kinetics helps discriminate acute from chronic illness
European Heart Journal (2016) 37, 267-315
IFCC Task Force on Clinical Applications of Cardiac Biomarkers (www.ifcc.org/201405)
AHA/ACC Guidelines - Cardiac Troponin Highlights
- 99th percentile for cardiac troponin is appropriate cutoff for considering myocardial necrosis
- For contemporary assays, serial cardiac troponin levels should be measured at presentation and 3 to 6 hours after symptom onset in all patients who present with chest pain symptoms. This identifies a rising and/or falling pattern
- In evaluating serial changes, absolute changes appear to have a significantly higher diagnostic accuracy for AMI than relative changes
Journal of the American College of Cardiology Vol 64 No. 24, 2014
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