Let's talk about change, cardiac troponin deltas: A step in the right direction

摘要

We read with great interest the paper by Cullen et al. "Delta troponin for the early diagnosis of acute myocardial infarction- (AMI) in emergency patients with chest pain" [1]. Using a sensitive cardiac troponin (cTn) assay there is a trade-off in which sensitivity improves whereas specificity decreases. Here lies the potential value of monitoring serial cTn "delta" changes with the main goal of improving diagnostic accuracy, or in other words improving clinical specificity [2]. Cullen et al. have sought to assess the accuracy of the absolute and relative cTn deltas at 2 or 6 h compared to the 99th percentile reference value cutoff at 2 and 6 h after presentation for the diagnosis of AMI utilizing the Beckman Coulter AccuTnl assay (this was not a high sensitivity assay). They also derived an algorithm defining the optimal cTn values for both rule-in and rule-out of AMI. This is an important study that adds further information to our current knowledge of serial cTn changes and we offer several points that need to be emphasized.