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I would like advice or opinions on how the cut-off for troponin should be defined in practice for the current assays. My apologies if this has been discussed before. The recommendation of the AHA/ESC committee on redefinition of MI, reinforced by an editorial in Clin Chem by Apple and Wu is that the cutoff should be the lowest concentration at 10% precision (unless that is lower than the 99th percentile of a healthy control population). However, there are data to show that patients with small increases in troponin that are clearly below the lowest concentration at 10% precision of the assay benefit as a group from intervention. See Morrow et al JAMA 2001 Nov 21 Vol 286 2405-12: At the cutoff used in this study of 0.1ng/ml for troponin I, the imprecision of the assay is 20%. The lowest concentration at 10% precision of the assay is 0.4ng/ml. The group with troponin I between 0.1 and 0.4ng/ml seemed to benefit from intervention. Which cut-off should we be reporting for individual patients in routine practice? Samuel Vasikaran Core Clinical Pathology and Biochemistry Royal Perth Hospital Phone (61) 8 9224 2453 Fax (61) 8 9224 2491 This email intended for the use of the addressee only Opinions expressed those of the author and not the institution ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/