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Editor's Correspondence
May 13, 2013

Routine Noninvasive Testing and Highly Sensitive Troponin Immunoassays

Author Affiliations

Author Affiliations: Unità Operativa Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio (Dr Lippi), and Unità Operativa Pronto Soccorso e Medicina d’Urgenza (Dr Cervellin), Azienda Ospedaliero–Universitaria di Parma, Parma, Italy.

JAMA Intern Med. 2013;173(9):834-835. doi:10.1001/jamainternmed.2013.3773

In a recent article published in this journal, Prasad et al1 reviewed the current practice of routine noninvasive testing in patients with chest pain admitted to the emergency department (ED). Although stress testing is currently recommended in those patients with nondiagnostic results of serial electrocardiograms and biomarkers, the definition of “negative cardiac biomarker findings” may be an important drawback in this approach. At the time when the American College of Cardiology/American Heart Association guidelines were released (ie, 2007), the designation of “nondiagnostic biomarker” was based on the so-called contemporary-sensitive troponin immunoassays, which generate measurable values in approximately 35% of a healthy population, at best.2 The recent development and gradual commercialization of the novel highly sensitive immunoassays represent a major breakthrough in the management of chest pain in the ED, considering that a large number of these patients have comorbidities that contribute to increase troponin concentration because of an increased turnover of myocardiocytes (eg, nonischemic heart injury) or impaired protein catabolism (eg, kidney disease).3,4 With this development, measurable troponin values can now be obtained in up to 96% of cases of a presumably healthy population, and thereby in virtually all subjects admitted to the ED.2

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