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Availability of highly sensitive troponin assays and acute coronary syndrome care: insights from the SNAPSHOT registry

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Recent community campaigns on the warning signs of a heart attack have significantly increased the number of patients presenting to emergency departments (EDs) with possible acute coronary syndrome (ACS).1 Concomitantly, the advent of assays with improved sensitivity for detecting circulating cardiac troponins (cTn) — which are fundamental to the diagnosis of acute myocardial infarction (AMI) — has allowed the detection of low concentrations of these biomarkers,2 and an increase in proportions of ED patients with AMI has been reported.3

There has also been an associated increase in the number of patients with an elevated cTn level that is not attributable to an unstable coronary artery plaque resulting in an ACS.3 It is recommended that patients in the ED who have an elevated troponin level have further assessment and/or management of the underlying cause, which often includes admission to hospital with resulting use of resources.4 Thus, there is continued debate among clinicians about the overall utility of these highly sensitive assays, and questions about the overall population benefits.

The diagnosis of myocardial infarction (MI) requires a characteristic dynamic profile of myocyte necrosis of cardiac biomarker(s), preferably a troponin (troponin I and…