Better, higher, lower, faster: increasingly rapid clinical decision making using high-sensitivity cardiac troponin assays

The diagnosis of acute myocardial infraction has undergone a noticeable transformation since
the introduction of the high-sensitivity cardiac troponin assays. The clear shift towards increasingly rapid
clinical decision making is reflected in the most recent European Society of Cardiology guidelines, which
include a 0-/1-hour algorithm for the diagnosis of non-ST-elevation myocardial infarction. The use of this
algorithm enables rule-in or rule-out in approximately 70–75% of all patients after a second cardiac troponin
measurement after one hour. In a minority of patients rule-in or rule-out is achievable even faster; after only
a single blood draw at presentation. Since rapid clinical decision making has several advantages, like fast
initiation of treatment for those who need it and preventing prolonged patient anxiety, various recent studies
have tried to further optimize these cut-off values at presentation.