In diagnosing acute coronary syndromes, which troponin measurement protocol is considered best practice?

The optimal troponin measurement protocol for diagnosing acute coronary syndromes (ACS) involves drawing troponins every 3-6 hours. This approach is grounded in the understanding of how troponin levels change over time in relation to myocardial injury.

Troponins are sensitive and specific biomarkers for myocardial necrosis, and they may not peak immediately after an acute event. Instead, they typically rise within several hours after injury and can remain elevated for days. By measuring troponin levels at intervals of 3 to 6 hours, clinicians can observe trends and changes that are clinically significant. This interval is long enough to capture the dynamic nature of troponin release while also allowing for timely evaluation of a patient's condition.

Measuring troponins at 1-hour intervals may lead to unnecessary procedures and stress for patients, as well as increased healthcare costs without significant benefit, since troponin release patterns typically do not change that rapidly in the context of ACS. Drawing troponins at admission only would miss the critical early changes that may indicate myocardial injury. Likewise, measuring troponins once daily would likely delay diagnosis and result in missed opportunities for timely intervention, as important changes in troponin levels could be overlooked.

In summary, the practice