Circulation 2011;124:2350-2354.
Evolution of the cardiac troponin assays and their diagnostic cutoffs
The 99th Percentile Rule
In the presence of a clinical history suggestive of ACS, the following is considered indicative of myocardial necrosis consistent with myocardial infarction: maximal concentration of cTn exceeding the 99th percentile of values for a reference control group on at least one occasion during the first 24 hours after the clinical event.
Causes of Elevated Plasma cTn Other Than ACS
Cardiac Causes
Noncardiac Causes
- Cardiac contusion resulting from trauma
- Cardiac surgery
- Cardioversion
- Endomyocardial biopsy
- Acute and chronic heart failure
- Aortic dissection
- Aortic valve disease
- Hypertrophic cardiomyopathy
- Tachyarrhythmia
- Bradyarrhythmia, heart block
- Apical ballooning syndrome
- Post–PCI
- Rhabdomyolysis with myocyte necrosis
- Myocarditis or endocarditis/pericarditis
- Pulmonary embolism
- Severe pulmonary hypertension
- Renal failure
- Stroke, SAH
- Infiltrative diseases, eg, amyloidosis
- Cardiotoxic drugs
- Critical illness
- Sepsis
- Extensive burns
- Extreme exertion
Serial Troponin Testing
Collecting a second specimen for cTn testing within 2 to 3 hours from the collection of the blood sample at presentation to help confirm the diagnosis of MI.
Troponin kinetics in the index cases
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