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In Reply I agree with the key distinction that Dr Ungerer and colleagues make between analytical and diagnostic sensitivity when comparing different troponin assays. The similar diagnostic sensitivity between the contemporary and highly sensitive assay for cardiac troponin I in the study by Keller et al1 can be explained by the fact that the contemporary assay had (1) sufficient analytical sensitivity and precision to characterize cardiac troponin I values at or below the 99th percentile threshold (the MI detection limit) and (2) the 99th percentile threshold had been accurately determined for both assays. Because many contemporary assays already detect troponin levels at or below the 99th percentile value, diagnostic sensitivity should not differ substantially between good contemporary assays for troponin and highly sensitive assays.
de Lemos JA. Assays for Cardiac Troponins—Reply. JAMA. 2013;310(14):1503-1504. doi:10.1001/jama.2013.276782