Letter by Mueller and Roffi 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:
We are concerned that major methodological limitations, especially the lack of a 1-hour measurement and exclusion of patients with ECG changes, as well as measurements affected by analytic errors, use of less sensitive and less accurate cardiac troponin (cTn) assays for adjudication, lack of central adjudication, and incomplete adjudication of patients with type II myocardial infarction, have led to inappropriate conclusions by Pickering et al.1 Despite the absence of a 1-hour measurement in the cohorts gathered for the analysis, the investigators attempted an assessment of the performance of the 0-hour/1-hour algorithm2 proposed by recent European Society of Cardiology (ESC) guidelines for the diagnosis of acute myocardial infarction (AMI). We believe that the mentioned methodological limitations have led …