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The promise of high-sensitivity troponin testing

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The benefits of diagnostic innovation rely on appropriate clinical practice reforms

The development of troponin T and I assays for assessing and managing patients with chest pain has revolutionised care for those with suspected or confirmed acute coronary syndromes.1 The availability of these assays has led to more patients who are at increased risk of recurrent cardiac events being identified, plus improvements in selecting patients who might benefit from early invasive management and revascularisation and more potent antithrombotic therapy. Development of point-of-care testing has extended the reach of these assays to inform the care of patients presenting in rural and remote areas of Australia.2

However, incremental improvements in analytical precision, with the emergence of assays that enable detection of serum troponin in up to half the apparently normal population, threaten to undo some of the initial gains offered by troponin testing.3 While increased sensitivity ensures that the problem of missed myocardial infarction (MI) is far less likely, it also creates the problem of reduced specificity. The consequence is a test with a lower positive predictive value for MI.

In this issue of the Journal, two articles highlight the practical implications of using assays with improved precision. One describes a large…