Correspondence |
Pitfalls and problems of relying on serum troponin
Sir,With regard to the paper by Burness et al. (Q J Med 2005; 98:365–71) on the pitfalls of using troponin T to diagnose myocardial infarction, it may have been helpful if there had been more than one measurement of troponin T in the cases described. The European Society of Cardiology and American College of Cardiology 2000 Consensus Document, in which the definition of myocardial infarction was redefined, stated the need to demonstrate a rise and fall of biochemical markers along with one or more of the following: ischaemic symptoms, appropriate ECG changes or cardiac intervention.1 In line with this, Collinson et al. state that a single estimation is insufficient. They recommend at least two and preferably three measurements, to show changing values.2 Additionally, one of the conclusions of the Multicentre Trial evaluating biochemical markers was that it was only in the presence of appropriate clinical or ECG findings that the elevation of cardiac troponin T would constitute an acute myocardial infarction, and the diagnosis should not be made on the basis of a cardiac troponin result alone.3
A second point is that the authors state the need for accurate diagnosis because of its effect on other aspects of the patient's life, one of which is obtaining life insurance. However, for those who already have critical illness insurance, there can be problems in the claims process if the definition of myocardial infarction has not been strictly met. This can lead to upset and confusion if a patient has been told that they have had a heart attack, but because of equivocal or incomplete biochemical and ECG data, the claim is delayed or even declined.
Whiston Hospital Prescot Merseyside
References
1. European Society of Cardiology/American College of Cardiology. Myocardial infarction Redefined—a Consensus Document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. Eur Heart J 2000; 21:1502–13.
2. Collinson PO, Stubbs PJ. Are Troponins Confusing? Heart 2003; 89:1285–7.
3. Collinson PO, Stubbs PJ, Kessler A-C. Multicentre Evaluation of the Diagnostic Value of Cardiac Troponin T, CK-MB Mass and Myoglobin for Assessing Patients with Suspected Acute Coronary Syndromes in Routine Clinical Practice. Heart 2003; 89:280–6.
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