Alcalai et al1 report a very well designed study on the significance of troponin elevation in hospitalized patients. However, the authors have coined a new term, nonthrombotic troponin elevation (NTTE). This term categorically implies an absence of thrombus in the coronary circulation. Coronary angiography was performed on only some of the patients in this group among whom no significant coronary lesions were found. Without performing a randomized study in which coronary angiography is performed in all of these patients, it cannot be absolutely confirmed that these patients did not have any plaque rupture in the coronary circulation. This could even represent the final cause of death in patients who have sepsis or renal failure. Particularly, in an era in which late thrombosis of drug-eluting stents has emerged as a major issue, this becomes ever more important. Development of thrombosis in a preexisting stent can be a final cause of death, which was not an enrollment criterion in this study. In addition, the evaluation of renal function was based on absolute creatinine levels. Instead, calculation of creatinine clearance by the Cockcroft-Gault equation could have been a better reference because absolute creatinine levels might not truly represent the extent of renal dysfunction, particularly in the elderly population.2 Remember, in the study by Alcalai et al,1 patients in the NTTE group were older.
Latif F. Nonspecific Troponin Elevation. Arch Intern Med. 2007;167(17):1906-1907. doi:10.1001/archinte.167.17.1906-b