Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin

Intern Emerg Med. 2017 Mar;12(2):147-155. doi: 10.1007/s11739-017-1612-1. Epub 2017 Feb 11.


The role of cardiac troponins as diagnostic biomarkers of myocardial injury in the context of acute coronary syndrome (ACS) is well established. Since the initial 1st-generation assays, 5th-generation high-sensitivity cardiac troponin (hs-cTn) assays have been developed, and are now widely used. However, its clinical adoption preceded guidelines and even best practice evidence. This review summarizes the history of cardiac biomarkers with particular emphasis on hs-cTn. We aim to provide insights into using hs-cTn as a quantitative marker of cardiomyocyte injury to help in the differential diagnosis of coronary versus non-coronary cardiac diseases. We also review the recent evidence and guidelines of using hs-cTn in suspected ACS.

Keywords: Acute coronary syndrome; Cardiac biomarkers; High-sensitivity cardiac troponin.

Publication types

  • Review

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Acute Coronary Syndrome / diagnosis*
  • Biological Assay / methods
  • Biomarkers / metabolism
  • Early Diagnosis
  • Humans
  • Primary Prevention / methods
  • Troponin / blood*
  • Troponin / metabolism


  • Biomarkers
  • Troponin