Evolution of Biochemical Diagnosis of Acute Coronary Syndrome – Impact Factor of High Sensitivity Cardiac Troponin Assays

In patients with acute thoracic pain and non-conclusive acute myocardial infarction electrocardiogram (non-STEMI), the biochemical diagnosis is an essential tool for its correct treatment. The study of the chosen biomarker for cardiac injury has raised interest during decades. The appearance of immunoassays to assess cardiac troponin I or T has reached great improvements in the diagnosis, evolution and prognosis of the Acute Coronary Syndrome (ACS), as well as in risk stratification of these patients and in patients with chronic cardiac diseases as heart failure or cardiomyopathies. Regarding the analytical sensitivity of the methods that evaluate cardiac troponin I or T these improvements have made possible to measure accurately very tiny seric concentrations of the protein (high sensitivity troponin) (hs-Tn). This fact, being positive in principle sometimes induces to reconsider if tiny seric concentrations of isolated troponin I or T are not due to acute myocardial infarction but to a less severe source which affects the myocardiocite, this will oblige us to assess the clinical presentation in depth.