Diagnostic and prognostic significance of high sensitive troponin in chest pain

Background and Objectives: Chest pain is one of the most frequent present- ing complaints among patients arriving to the Emergency Department. In this population, the prevalence of acute coronary syndrome is about 25% instead that of acute myocardial infarction ranges from 5 to 15%. The diagnostic challenge for the emergency physician is the early rule-in or rule out of acute myocardial infarction within first few hours after chest pain presentation, par- ticularly in those patients with normal or not sig- nificant electrocardiogram. Evidence and Information Sources: The current review is based on an analysis of most important clinical trials on this topic. State of the Art: The universal current guide- lines established that the term "myocardial infarc- tion" should be used when there is evidence of myocardial necrosis of ischemic origin, as docu- mented by an increase of myocardial necrosis markers. Actually, cardiac troponins are consid- ered the standard biomarkers for acute myocar- dial infarction diagnosis, because are more supe- rior in sensitivity and specificity to the other avail- able markers. Perspectives: More recently, high sensitive troponin assays have been developed, permit- ting the early measurement of very low concen- trations. Conclusion: In this review, we analyzed the diagnostic and prognostic significance of these new high sensitive troponins in Emergency De- partment chest pain management.