American College of Cardiology Foundation Recommendations Assume Incorrectly That Cardiac Troponins T and I Are Equally Cardiac Specific

摘要

The American College of Cardiology Foundation (ACCF), in collaboration with the American Heart Association and other organizations, has produced recommendations designed to help clinicians with the practical interpretation of elevated cardiac troponin (1). The document can be regarded as a companion to the also recently published "Third Universal Definition of Myocardial Infarction" (2). By necessity, the recommendations in the 2 documents are harmonized. This unfortunately also means that a fundamental error in one has been repeated in the other. Both documents refer to cardiac troponin (cTn) as one entity and make no distinction between cTnT and cTnl. Elevation of either marker in the circulation is viewed as virtually diagnostic of myocardial necrosis. There are important biological and analytical differences between the 2 cardiac troponins that directly affect diagnosis and decision making.