Nonspecific Troponin Elevation—Reply

In reply

We thank Latif for his knowledgeable comments. The term NTTE was used by us¹ and previously by Jeremias et al² to describe a clinical state in which the cause for troponin elevation is not an acute thrombotic event in the coronary arteries. Though the term NTTE implies the absence of thrombus in the coronary circulation, still, it is a clinical diagnosis based on several factors of which coronary angiography is only one. Similarly in the case of acute coronary syndrome, which implies the presence of thrombus in the coronary circulation, the diagnosis is based on the whole clinical presentation rather than the coronary angiogram.³ Furthermore, the absence of coronary thrombus or obvious rupture plaque cannot rule out the diagnosis of acute coronary syndrome (ACS) if the clinical presentation is highly suggestive; hence, it cannot rule in the diagnosis of NTTE. To our understanding, it is unnecessary to catheterize all patients with elevated troponin levels to reliably distinguish between ACS and NTTE.