The 2021 American Heart Association/American College of Cardiology/American Society of Echocardiography/American College of Chest Physicians/Society for Academic Emergency Medicine/Society of Cardiovascular Computed Tomography/Society for Cardiovascular Magnetic Resonance guidelines for the evaluation and diagnosis of acute chest pain make important recommendations that include the recognition of high-sensitivity cardiac troponin (hs-cTn) as the preferred biomarker, endorsement of 99th percentile upper reference limits to define myocardial injury, and the use of clinical decision pathways, as well as acknowledgment of the uniqueness of women and other patient subsets. Details on how to integrate hs-cTn into clinical practice are less extensively addressed. Clinicians should be aware of some of the analytical aspects related to hs-cTn assays regarding the limit of detection and the limit of quantitation and how they are used clinically, especially for the single sample strategy to rule out acute myocardial infarction. Likewise, it is important for clinicians to understand issues related to the derivation of the 99th percentile upper reference limit; the value of sex-specific 99th percentile upper reference limits; how to use changing concentrations (deltas) to facilitate diagnosis and risk stratification of patients with suspected acute coronary syndrome, including the differentiation of acute from chronic myocardial injury; and how to best integrate the use of hs-cTn with clinical decision pathways. With the use of hs-cTn, conditions such as type 2 myocardial infarction become more common, whereas others such as unstable angina become less frequent but still occur. Sections relating to these issues are included.

中文翻译：

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高敏心肌肌钙蛋白和 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR 急性胸痛评估和诊断指南

2021 年美国心脏协会/美国心脏病学会/美国超声心动图学会/美国胸科医师学会/学术急救医学学会/心血管计算机断层扫描学会/心血管磁共振学会急性胸痛的评估和诊断指南使重要建议，包括将高敏心肌肌钙蛋白 (hs-cTn) 识别为首选生物标志物、认可第 99 个百分位参考上限来定义心肌损伤、使用临床决策途径，以及承认女性和其他患者亚群。关于如何将 hs-cTn 整合到临床实践中的细节没有得到广泛讨论。临床医生应该了解与 hs-cTn 检测有关的一些分析方面，包括检测限和定量限以及它们在临床上的应用，尤其是对于排除急性心肌梗死的单一样本策略。同样，临床医生了解与推导第 99 个百分位参考上限相关的问题也很重要；特定性别的第 99 个百分位数参考上限值；如何使用变化的浓度 (delta) 来促进疑似急性冠脉综合征患者的诊断和风险分层，包括区分急性和慢性心肌损伤；以及如何最好地将 hs-cTn 的使用与临床决策途径结合起来。随着 hs-cTn 的使用，2 型心肌梗塞等疾病变得更加普遍，而其他如不稳定型心绞痛则变得不那么频繁，但仍然会发生。包括与这些问题相关的章节。