We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Sensitive Troponin I Assay in Patients With Suspected Acute Coronary Syndrome

Allan S. Jaffe, MD; Bertil Lindahl, MD, PhD; Hugo A. Katus, MD
JAMA. 2011;306(5):488-489. doi:10.1001/jama.2011.1062.
Text Size: A A A
Published online


To the Editor: The study on the use of a contemporary sensitive troponin assay and its association with reductions in death and recurrent MI used a diagnostic threshold of troponin of 0.05 ng/mL, based on a coefficient of variation (CV) of less than 10% at that level.1 However, the 99th percentile reference value of 0.012 ng/mL would have been preferable as the diagnostic threshold because this is the value recommended by guidelines groups.2 This cutoff value optimizes the identification of patients at risk with ACS in all studies that have explored this issue.2 There are many reasons for the reluctance of clinicians to use the 99th percentile value, but one reason often cited is that the assay does not have imprecision less than 10% at that value. The Biochemistry Group of the Global Task Force for the Universal Definition of Acute Myocardial Infarction and the Global Task Force itself have for years advocated for this level of imprecision at the 99th percentile value but have never suggested using a less sensitive value when this level of imprecision is not met2,3 because the 99th percentile value maximizes clinical outcomes. In addition, modest increases in imprecision do not cause false-positive values whether used for diagnosis4 or prognosis.5 However, increased imprecision can affect the ability to observe serial changes.3


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




August 3, 2011
Jeffrey D. Clough, MD, MBA; Seth S. Martin, MD; Matthew W. Cope, MD
JAMA. 2011;306(5):488-489. doi:10.1001/jama.2011.1061.
August 3, 2011
Nicholas L. Mills, MD, PhD; Simon Walker, DM, FRCPath; David E. Newby, FMedSci
JAMA. 2011;306(5):488-489. doi:10.1001/jama.2011.1063.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.