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August 3, 2011

Sensitive Troponin I Assay in Patients With Suspected Acute Coronary Syndrome

Author Affiliations

Author Affiliations: Department of Medicine, Duke University Health System, Durham, North Carolina (jeffrey.clough@duke.edu).

JAMA. 2011;306(5):488-489. doi:10.1001/jama.2011.1061

To the Editor: Dr Mills and colleagues1 demonstrated a significant reduction in myocardial infarction (MI) and death in patients with suspected acute coronary syndrome (ACS) through use of a lower-threshold troponin assay.

One surprising finding was a modest increase in use of recommended therapies in patients with plasma troponin concentrations of 0.05 to 0.19 ng/mL during the implementation phase, which would be expected to result in reduced events. In fact, revascularization rates were stable despite more than a doubling in coronary angiography. Aspirin, β-blocker, and angiotensin-converting enzyme inhibitor use did not differ between the phases. Although more statins were prescribed at discharge in the implementation phase, a similar difference was present on admission, suggesting possible baseline differences between these nonrandomized samples.