Use of troponins in clinical practice: Evidence in favour of use of troponins in clinical practice

[...]with hs-cTn assays, MI subsumes only a modest percentage of the increases observed.4 For laboratory medicine, there are challenges with service delivery based on the use of diagnostic algorithms incorporating an admission measurement with repeat measurement at 1–3 hours post-admission.1 For journals, including readers, editors and their reviewers, there is also the challenge of understanding and educating hs-cTn users on the nature of the improved analytics of hs-assays, how they differ from existing assays and how to implement them into routine clinical practice and validate their performance. [...]there was a desire to make the decision limit more exacting, that is,1% rather than 2.5%. [...]the authors talk about the ‘true’ 99th percentile calculated based on values for outpatients, emergency department patients and sick inpatients including those in intensive care units. [...]most concerning is that the authors imply in their manuscript that the current approach, which has been universally in place and supported globally for almost 20 years using the 99th percentile of a reference healthy population, is misleading and that different values should be used.