Letter by Irfan Regarding Article, “Assessment of the European Society of Cardiology 0-Hour/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial Infarction”
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To the Editor:
I agree with the editorial1 on the Pickering et al2 article that troponin-based rule-in should be termed “rule-in myocardial injury.” However, these algorithms should more appropriately be termed “rule in/out acute myocardial damage as detected by troponin,” and they need to perform better.
First, even when “ruled-out” for acute myocardial infarction (AMI) by the proposed criteria, there might be patients with elevated baseline troponins, which signify myocardial injury. Because these troponin levels are not acutely changing, the criteria rule out acute myocardial injury (including AMI) but not chronic myocardial injury. The criteria should ideally distinguish between ruled-out patients with AMI and those with elevated but stable troponin levels, who are at higher risk than those with undetectable troponin levels.3 Until …