Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

To the Editor: Neumann et al. (June 27 issue) 1 propose a new risk-assessment tool for patients with suspected myocardial infarction. However, renal function and sex have a considerable influence on cardiac troponin concentrations. The 99th percentile of the normal reference range for cardiac troponin increases with age. 2-4 Patients with renal impairment also have higher baseline cardiac troponin concentrations than those without renal impairment. 5,6 Lower estimated glomerular filtration rates are associated with higher cardiac troponin concentrations (especially concentrations of cardiac troponin T). In these patients with lower estimated glomerular filtration rates, the use of a single cardiac troponin value that is . . .