Use of troponins in clinical practice: Evidence against the use of troponins in clinical practice

We have read with interest the paper by Collinson et al,1 and we are grateful for an opportunity to respond to their comments, especially those that relate to our recent BMJ paper describing the Is the current threshold for diagnosing raised highly sensitive troponin apparopriate for a hospital population? (CHARIOT) study.2

The use of more sensitive troponin assays in UK hospitals is now universal. The frontline clinical staff who request and then interpret the test belong to a wide range of clinical specialties. The concept for CHARIOT emerged out of our observations that there was an important mismatch in actual clinical practice between the extremely precise guidelines that lay out how these assays should be employed to rule out myocardial infarction (MI), or diagnose MI or myocardial injury, and their actual use. Specifically, there are important and widespread misconceptions about how troponin values should be…

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