Delta Troponin for early diagnosis of myocardial infarction

Delta Troponin for early diagnosis of myocardial infarction

Delta Troponin has been endorsed for early diagnosis of myocardial infarction in the recommendations for unstable angina and non ST elevation myocardial infarction. Delta Troponin is not a new test, but the difference in values between serial tests. For example 2h Delta Troponin would mean the difference between the value taken at presentation in the emergency department and a repeat value obtained after 2 hours.

Serial rise in cardiac troponin values over a two hour period has more diagnostic value than a single test and can indicate myocardial infarction even before the levels have risen above the standard cut off values for the diagnosis of myocardial infarction by a single test. Each facility has to establish a fast method of getting these tests done so that the difference in serial values can be calculated. The optimal time for reporting a test should be around one hour so as to be clinically useful.

Point of care testing of biomarkers in the emergency department have been evaluated in some centers to expedite early diagnosis, but tends to be more costly than regular estimations in the central laboratory. Kits  with good reliability are becoming available for point of care test. ACC/AHA Guideline for the Evaluation and Diagnosis of Chest Pain 2021 has used delta troponin for the definition of low risk patients with chest pain [1].

Reference

1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O’Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Nov 30;144(22):e368-e454. doi: 10.1161/CIR.0000000000001029. Epub 2021 Oct 28. Erratum in: Circulation. 2021 Nov 30;144(22):e455. PMID: 34709879.