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Even though the correspondence is about Trop-I my experience with Trop-T is
that one has to develope one's own cutoffs and not rely on the literature.
With the difference in results in external QC the reason is obvious.
Similarly, the practice of the hospital physicians influences the cutoff
and really one needs to know what question is being asked before one can
choose a cutoff. We use different ones for sensitivity ie keep and observe
in the Emergency Department and for specificity ie admit to the CCU. When
we were setting up the assay we compared it to positive CK-MB for 120
patients with a full blind chart review by me and in the case of a complex
diagnosis eg Rt sided failure with pneumonia and neither an obvious MI or
no MI a blind review by the cardiologist. Taking values from the literature
will only lead to the quantitative Troponin losing its value as a highly
selective discriminator of MI and unstable/at risk angina.

Elizabeth Mac Namara



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