Cardiac markers of myocardial necrosis: a history and discussion of milestones and emerging new trends.

Laboratory testing for blood-based biomarkers of myocardial injury has steadily evolved over the past 60 years. Initial assays were cumbersome and were neither sensitive nor specific for myocardial necrosis. Major improvements have included the development of more cardiospecific markers, the introduction of random access immunoassays that facilitated near-real-time reporting of results, the development of rapid whole-blood point-of-care testing, and progressive improvements in assay design leading to modern high-sensitivity troponin assays that are now being introduced to the market. These new high-sensitivity assays will dramatically change the approach to patients presenting with acute coronary syndromes.