Head-to-head comparison of three different high-sensitivity cardiac troponin assays for early rule-in and rule-out of acute myocardial infarction

The blood-based biomarkers cardiac troponin T and cardiac troponin I are used by clinicians to aid the diagnosis of acute myocardial infarction (AMI) and any other myocardial injury (1,2). The first assays for measurement of cardiac troponin plasma concentrations were developed in the early 1990s. Since then, continuous efforts were undertaken to improve the analytical precision of cardiac troponin assays at low analyte concentrations (2). According to current guidelines, the analytical coefficient of variation (CV) of cardiac troponin assays should be <10% at the 99th percentile upper reference limit (URL) of a normal reference population (2). In addition, the same guidelines claim that cardiac troponin assays should measure analyte concentrations above the limit of detection (LOD) in ≥50% of a normal reference population (2). If cardiac troponin assays are able to meet these two requirements, they are termed high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) assays (2).