High-sensitivity troponin tests for the early rule out of NSTEMI

Key points

In 2018 to 2019 cardiac conditions were responsible for over half a million emergency department attendances per year in England. There are around 75,000 emergency admissions annually for heart attack.

Cardiac troponin I and cardiac troponin T are biological markers that are released into the circulation when cardiac muscle is damaged. Troponins I and T are the recommended biomarkers for diagnosing myocardial infarction in NICE's guideline on chest pain of recent onset. It can take up to 12 hours after a heart attack for troponin levels to rise significantly.

Using non-high-sensitivity versions of the troponin assays can mean a prolonged stay in hospital and multiple blood tests to safely rule out non‑ST‑segment‑elevation myocardial infarction (NSTEMI). High‑sensitivity troponin assays were developed to detect troponin in the blood at lower levels than non-high-sensitivity troponin assays. Using the high-sensitivity assays as part of an early rule-out protocol can reduce time to discharge.

NICE's diagnostics guidance on early rule out of NSTEMI recommends 11 high-sensitivity troponin assays as options to use with several test strategies for the early rule out of NSTEMI in people presenting to an emergency department with chest pain and suspected acute coronary syndrome.