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COMMENTS AND OPINIONS
Are Guideline-Based Therapies for Myocardial Infarction Generalizable to Troponin-Only Positive Patients?—Reply
JoAnne M. Foody, MD
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In reply
We appreciate Horton's concerns regarding the potential heterogeneity in mechanisms of myocardial ischemia and causes of elevated troponin level. However, for the purposes of this analysis only, Medicare beneficiaries with a discharge diagnosis of acute MI were included in the analysis. Furthermore, while we recognize that troponin level may be elevated in several other syndromes beyond acute coronary syndromes, troponin is the gold standard for the diagnosis of MI because of its superior specificity and sensitivity for myocardial damage and greater ability to risk stratify patients with ischemic myocardial necrosis. In 2000, a new definition of MI was proposed that emphasized the use of cardiac troponins as the preferred marker of myocardial necrosis in the context of ischemic symptoms in routine clinical practice. Based on substantial data, troponin measurement has also been included as a fundamental component of diagnosis and risk stratification of MI . . . [Full Text of this Article]
AUTHOR INFORMATION
RELATED ARTICLE
Association of Troponin Status With Guideline-Based Management of Acute Myocardial Infarction in Older Persons
Rahman Shah, Jared Selter, Yun Wang, Michael Greenspan, and JoAnne M. Foody
Arch Intern Med. 2007;167(15):1621-1628.
ABSTRACT
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RELATED LETTER
Are Guideline-Based Therapies for Myocardial Infarction Generalizable to Troponin-Only Positive Patients?
Heather Horton
Arch Intern Med. 2008;168(4):436-437.
EXTRACT
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