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[Correspondence] Measurement of cardiac troponin for exclusion of myocardial infarction

In a prospective cohort study using a high-sensitivity cardiac troponin assay, Anoop Shah and colleagues1 determined an optimal threshold of circulating troponin to identify patients suitable for immediate discharge among those presenting to emergency departments with suspected acute coronary syndrome. The threshold of less than 5 ng/L could identify almost two-thirds of patients without myocardial infarction along with a high negative predictive value of 99·6% in the entire cohort. These findings are probably generalisable, because a recent meta-analysis of 23 studies,2 which evaluated troponin concentrations using a different high-sensitivity assay, generated similar results, and found that the threshold of 3–5 ng/L will miss up to 1% of patients with myocardial infarction.

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