Author Affiliations: Medical Oncology Branch, National Cancer Institute/National Institutes of Health, Bethesda, Maryland (Dr Prasad); and Departments of Medicine, Northwestern University (Dr Cheung) and University of Chicago (Dr Cifu), Chicago, Illinois.
Correspondence: Dr Prasad, Medical Oncology Branch, National Cancer Institute/National Institutes of Health, 10 Center Dr, Building 10, Room 12N226, Bethesda, MD 20892 (firstname.lastname@example.org).
Lippi and Cervellin discuss the implications of next-generation troponin assays. There are several issues worth considering. First, regarding the problem we initially described1—that current guidelines sanction noninvasive, provocative testing in all patients whose pain resolves and who “rule out” for myocardial infarction (MI)—it is hard to imagine the situation getting worse. Already, these patients, who are at extremely low risk, are being subjected to a series of interventions that increase the diagnosis of coronary artery disease (CAD) but fail to show any improvement in real outcomes. At some cutoff, results of high-sensitivity assays, like troponin T, will be positive in nearly all patients with stable coronary disease,2 as Lippi and Cervellin note. Will these patients be treated as if they are having plaque rupture or continue to be subject to further noninvasive testing? Either way, our efforts may not confer benefit.
Prasad V, Cheung M, Cifu A. Routine Noninvasive Testing and Highly Sensitive Troponin Immunoassays—Reply. JAMA Intern Med. 2013;173(9):834-835. doi:10.1001/jamainternmed.2013.4089