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Controversies and Cutting Edge

High-Sensitivity Troponin Testing

The ability of modern troponin assays to detect smaller and smaller levels of circulating troponin continues to improve. The United States Food and Drug Administration approved the first high-sensitivity troponin T assay for use in the United States in January 2017, though several other high-sensitivity assays have been used outside of the United States since 2009.116 These high-sensitivity assays have been shown to lead to earlier diagnosis of myocardial infarction, potentially decreasing ED length of stay and time to disposition or definitive treatment.117 They also increase the NPV of a normal troponin level, improving risk stratification and prognostication.118-120

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