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Impact of high-sensitivity cardiac troponin I assays on patients presenting to an emergency department with suspected acute coronary syndrome

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Cardiac troponins have long been used as the biomarker of choice to aid the diagnosis of acute myocardial infarction (AMI).1 In the consensus document on the universal definition of myocardial infarction, a key component in making the diagnosis of AMI is a rise and/or fall in levels of cardiac biomarkers, with at least one value above the 99th percentile value for a reference population.2 Recently, high-sensitivity cardiac troponin (hscTn) assays were introduced into clinical practice in Australia. These assays have improved detection at the lower limits of troponin levels, enabling troponin levels to be measured even in healthy individuals.3,4 They have been shown to detect myocardial infarction earlier than previously used assays.58 In addition, hscTn assays identify more patients with myocardial damage and those who are at an increased risk of future cardiac events.9,10 However, with this increase in sensitivity comes a reduced specificity.6,11 Consequently, more patients may be labelled with a diagnosis of acute coronary syndrome (ACS).