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Editor's Correspondence |

Misconstrued Intentions: Setting the Record Straight

Victor Novack, MD, PhD; David J. Cohen, MD, MSc; Donald E. Cutlip, MD
Arch Intern Med. 2012;172(18):1425-1427. doi:10.1001/archinternmed.2012.3752.
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We read with interest the Invited Commentary by Drs Alpert and Jaffe1 on our article “Troponin Criteria for Myocardial Infarction After Percutaneous Coronary Intervention.”2 Although they make several excellent points and we agree with many of their assertions, we believe that several issues that they have raised warrant comment.

In particular, we were disappointed to discover that the objective and major conclusions of our study were misinterpreted within the commentary. As clearly outlined in the article, our aim was to compare the effects of a troponin- or creatine kinase–MB (CKMB)-based definition of periprocedural myocardial infarction (MI) on event frequency and the association of these events with 1-year mortality. Our results indicated a significant difference in sensitivity such that the frequency of troponin MI (troponin values >3 times the upper limit of normal [ULN]) was more than 3-fold higher than CKMB MI (CKMB values >3 times the ULN). Moreover, although elevations of both troponin and CKMB levels were prognostically important, a comparable association between biomarker elevation and 1-year mortality was observed at much higher relative elevations of troponin than CKMB. Our article did not suggest a preference for CKMB or state that CKMB assays were more reliable based on longer-term use.

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October 8, 2012
Allan Jaffe, MD; Joseph Alpert, MD
Arch Intern Med. 2012;172(18):1425-1427. doi:10.1001/archinternmed.2012.4125.
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