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December 24, 1997

False-Negative Qualitative Cardiac Troponin T in a 79-Year-Old Man With Myocardial Infarction

Author Affiliations

Mallory Institute of Pathology Boston Medical Center
VA Medical Center Boston, Mass

JAMA. 1997;278(24):2143-2144. doi:10.1001/jama.1997.03550240033027

To the Editor.  —Cardiac troponin T (cTnT) thought to be a more specific indicator of myocardial cell necrosis than serum creatine kinase—MB (CK-MB).1-3 The CardiacT assay is the Food and Drug Administration—approved point-of-care device increasingly used in the detection of cTnT. To our knowledge, this is the first report of a case in which the CardiacT assay failed to detect myocardial infarction (MI) in contradiction to other biochemical markers.A 79-year-old man, with a history of non-Q wave MI and chronic stable angina diagnosed 7 years earlier, presented to the emergency department with complaints of chest pain while walking. Cardiac examination showed a normal S1, S2, no S3, and a grade 2/4 harsh systolic murmur that was heard best at the right upper sternal border. A 12-lead electrocardiogram (ECG) demonstrated a sinus rhythm with a rate of 92 and right bundle branch block. Laboratory data are