Cardiac troponin levels have a central role in the diagnosis
of acute myocardial infarction.10 After exclusion of STsegment
elevation and dynamic ST-segment electrocardiographic
changes, serial biomarker testing identifies the
remaining patients with acute myocardial infarction. Protocols
for the use of serial troponin measurements have
largely been based on release kinetics in experimental conditions
and have tended to require waiting 6–8 hours (or
longer) after presentation for the second test. Recent
advances in high-sensitivity assays that allow a much
shorter interval of 2 hours before the second test and
incorporation of serial biomarker levels into overall risk
stratification models (Box 4) have demonstrated safe accelerated
processes with robust clinical outcome data.11,12
These approaches have yet to be incorporated into clinical
guidelines, but almost certainly will be in the foreseeable
future.