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Clinical Chemistry 48: 2080-2082, 2002;
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(Clinical Chemistry. 2002;48:2080-2082.)
© 2002 American Association for Clinical Chemistry, Inc.

Letters


Drs. Wu and Apple respond:

Alan H.B. Wu1a and Fred S. Apple2

1 Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102

2 Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, University of Minnesota, School of Medicine, Minneapolis, MN 55415

aAuthor for correspondence. E-mail awu@harthosp.org.

The first 20% of the full text of this article appears below.


To the Editor:

The letter by Tate et al. attempts to resolve the issue of which cutoff concentration for troponin should be used in the diagnosis of myocardial infarction (MI) and risk assessment of acute coronary syndrome (ACS) patients. One of the underlying goals of the European Society of Cardiology (ESC)/American College of Cardiology (ACC) (1) and American Heart Association (AHA)/ACC guidelines (2) as well as the IFCC (3) recommendations for establishing a MI cutoff at a concentration with a 10% CV was to challenge manufacturers of cardiac troponin assays to improve the low-end analytical characteristics at the 99th percentile reference limit, to better identify ACS patients who are at higher risk of short- and long-term cardiac events. Our profession demands evidence-based studies to validate each troponin assay individually, addressing 99th percentile reference limits with appropriately powered numbers for gender and race, with MI diagnostic findings and risk-stratification information based on these reference limits. Clearly, the growing evidence-based literature supports the notion that any measurable troponin in ACS patients has pathologic significance for risk assessment independent of an assay’s analytical precision.

At present we suggest that both the laboratory medicine and clinical communities rally behind the ESC/ACC and AHA/ACC guidelines, which are supported by the IFCC Committee on Standardization of Markers of Cardiac Damage (CSMCD), which proposed the troponin 99th percentile reference limit for MI detection if a 10% CV can be attained. For assays for which the . . . [Full Text of this Article]






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