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Response: a novel troponin I rule-out value below the upper reference limit for acute myocardial infarction
  1. Andrew R Chapman,
  2. Atul Anand,
  3. Anoop S V Shah,
  4. Philip D Adamson,
  5. Nicholas L Mills
  1. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Andrew R Chapman, BHF/University Centre for Cardiovascular Science, University of Edinburgh, Room SU305, Chancellor's Building, Edinburgh EH16 4SB, UK; A.R.Chapman{at}ed.ac.uk
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http://dx.doi.org/10.1136/heartjnl-2016-309958

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    To the Editor,

    Goorden et al aim to establish the optimal threshold to rule out myocardial infarction using a high-sensitivity cardiac troponin I assay. They report that a cardiac troponin I concentration <10 ng/L or a change of <20 ng/L on serial testing had a negative predictive value for the diagnosis of myocardial infarction of 99.8% and 98.7%, respectively.1 While we agree that there are better approaches to rule out myocardial infarction than using the 99th centile upper reference limit,2 ,3 we have several …

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