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Vol. 76. Issue 6.
Pages 468-472 (June 2023)
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Vol. 76. Issue 6.
Pages 468-472 (June 2023)
Review article
Implementation of the ESC 0 h/1 h high-sensitivity troponin algorithm for decision-making in the emergency department
Aplicación del algoritmo 0 h/1 h de troponina de alta sensibilidad de la ESC para la toma de decisiones en el servicio de urgencias
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Maria Rubini Gimeneza,b,
Corresponding author
, Jasper Boeddinghausb,c, Thomas Nestelbergerb, Luca Koechlinb, Pedro López-Ayalab, Christian Müllerb
a Department of Cardiology and internal Medicine, University Heart Center Leipzig, Leipzig, Germany
b Cardiovascular Research Institute of Basel, University Hospital Basel, Basel, Switzerland
c BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Table 1. Assay-specific cutoff levels in ng/L within the 0h/1h and 0h/2h algorithm
Abstract

Diagnosis of non–ST-segment elevation acute coronary syndromes (NSTEACS) is based on 3 cornerstones: clinical presentation, 12-lead electrocardiogram, and cardiac troponin measurement. Advances in the development of high-sensitivity cardiac troponin (hs-cTn) assays have substantially improved the detection of cardiomyocyte injury in a shorter time period, and hs-cTn has consequently been established as the gold-standard biomarker for the assessment of patients with suspected NSTEACS. The implementation of these assays in clinical practice allows a faster “rule-out”, especially among low-risk patients, as well as a safer and more rapid “rule-in”, with its therapeutic consequences. Current guidelines for the diagnosis of NSTEACS recommend the use of hs-cTn applied in rapid diagnostic algorithms based on serial hs-cTn sampling within the first few hours. The current work provides an overview of the use of hs-cTn for the early detection of NSTEACS.

Keywords:
Acute myocardial infarction
High-sensitivity cardiac troponin
Rapid algorithms
Abbreviations:
ACS
ED
hs-cTn
MI
NSTEACS
NSTEMI
Resumen

El diagnóstico de los síndromes coronarios agudos sin elevación del segmento ST (SCASEST) se basa en 3 pilares fundamentales: la presentación clínica, el electrocardiograma de 12 derivaciones y la medición de la troponina cardiaca. Los avances en el desarrollo de ensayos de troponina cardiaca de alta sensibilidad (hs-cTn) han permitido mejorar sustancialmente la capacidad de detectar daño miocárdico en un periodo de tiempo más breve, por lo que la hs-cTn se ha establecido como el biomarcador de referencia en la evaluación de pacientes con sospecha de SCASEST. Su implementación en la práctica clínica permite una confirmación del diagnóstico más rápida, especialmente entre los pacientes de bajo riesgo, así como un descarte del mismo más seguro y rápido, con sus consecuencias terapéuticas. Las guías actuales para el diagnóstico del SCASEST recomiendan el uso de la hs-cTn aplicada en algoritmos de diagnóstico rápido basados en la toma de muestras seriadas de hs-cTn en las primeras horas. El presente trabajo ofrece una visión general sobre el uso de la hs-cTn para la detección precoz del SCASEST.

Palabras clave:
Infarto agudo de miocardio
Troponina cardiaca de alta sensibilidad
Algoritmos rápidos

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