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The Reply

  • Tobias Reichlin
    Affiliations
    Department of Cardiology, University Hospital, Basel, Switzerland

    Department of Internal Medicine, University Hospital, Basel, Switzerland

    Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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  • Christian Mueller
    Affiliations
    Department of Cardiology, University Hospital, Basel, Switzerland

    Department of Internal Medicine, University Hospital, Basel, Switzerland
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      We thank Lippi and Cervellin for their interest in our work and for sharing their observation in 71 patients presenting with chest pain from causes other than acute myocardial infarction to the emergency department.
      • Reichlin T.
      • Twerenbold R.
      • Reiter M.
      • et al.
      Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis.
      Their findings are important and interesting. However, the authors provide 2 conclusions that are not supported by their findings. First, we would argue that the question of whether the clinical implications of transition from sensitive to high-sensitivity methods can be generalized requires testing in appropriately powered large diagnostic and prognostic studies. Second, we would argue that the same applies to the evaluation of the potential diagnostic superiority of high-sensitivity AccuTnI (Beckman Coulter, Inc, Brea, Calif) versus sensitive AccuTnI, particularly because this assessment will require more than the measurement at presentation.

      Reference

        • Reichlin T.
        • Twerenbold R.
        • Reiter M.
        • et al.
        Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis.
        Am J Med. 2012; 125: 1205-1213

      Linked Article

      • Assay Characteristics and Diagnostic Improvement from Contemporary to High-sensitivity Troponin I Immunoassays
        The American Journal of MedicineVol. 126Issue 9
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          In a recent study, Reichlin et al1 concluded that the introduction of a high-sensitivity troponin T immunoassay leads to only a modest increase in the incidence of acute myocardial infarction in the emergency department. To verify whether similar conclusions may be replicated using a latest-generation, high-sensitivity troponin I immunoassay, we planned a clinical investigation comparing the results of the prototype Beckman Coulter (Brea, Calif) HS-AccuTnI with those of the previous “contemporary-sensitive” Beckman Coulter AccuTnI method.
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