The analytical performance of troponin assays has improved markedly in the last 2 decades. The variety of assays, their evolution over time, and their critical importance in influencing care, mandates the need for skills in their use. There are 3 critical elements necessary for optimal use of troponin testing in clinical care, as follows: 1) the analytical performance of the assay; 2) the clinical sensitivity and specificity of the test result; and 3) the clinical reasoning for ordering and the proper clinical context for interpreting the test result. This paper provides further explanation that will assist clinicians in their clinical decision making and interpretation of troponin test results. Schematic visual expla- nations are provided to help clinicians develop a more intuitive understanding of troponin testing.

(J Am Coll Cardiol 2016;68:2365–75) © 2016 by the American College of Cardiology Foundation.