In their 2021 updated guidelines, the AHA/ACC Joint Committee on Clinical Practice Guidelines wrote, "There is ample evidence for the superiority of hs-cTn assays over conventional cTn assays in multiple aspects of evaluation for patients presenting with chest pain with and without AMI. The sensitivity and negative predictive values are greater with hs-cTn compared with previous generation assays. In addition, the time interval from onset of chest pain to a detectable concentration at patient presentation is shorter with hs-cTn, affording more rapid rule-in and rule-out algorithms."2
The committee notes that clinicians have to learn how to appropriately use hsTn assays. They must be familiar with the analytical performance properties of the assay(s) that are used in their practice as it is easy to misinterpret results given the extreme sensitivity of these assays. The use of the terms 'normal' and 'abnormal' to describe hs-cTn levels should be avoided; instead, the terms 'non-elevated' and 'elevated' should be used when referring to hs-cTn levels below and above the 99th percentile.3
2. Gulati, M, Levy, P, Mukherjee, D, et al. "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines." Circulation, Vol 144, 28 Oct 2021. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001030.3. European Society of Cardiology. "2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)." Eur Heart J, Volume 44, Issue 38, 7 Oct 2023, pages 3720–3826, https://doi.org/10.1093/eurheartj/ehad191.
