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To the Editor: In their study of the rates of death and heart failure in ACS, Dr Fox and colleagues¹ used data from the Global Registry of Acute Coronary Events (GRACE) collected between July 1, 1999, and December 31, 2006. During this time period, the use of troponin enzymes in diagnosis of ACS became very widespread and replaced previous enzyme markers.² Troponin use is associated with a greater likelihood of hospitalization for ACS than older enzymatic tests.³ The possible effects of such an increase on their results are not well addressed in their article. If, over time, more patients are hospitalized for non–ST-segment elevation ACS because of the sensitivity of the troponin test that was introduced during this time, rates of death and adverse outcome in the later years of the study may appear artifactually low when compared with patients diagnosed previously with less sensitive tests.

In addition, the authors . . . [Full Text of this Article]

Lydia A. Bazzano, MD, PhD
lbazzano@tulane.edu
Department of Epidemiology
Tulane University School of Public Health and Tropical Medicine
New Orleans, Louisiana

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