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Stephen R. Beck, MD
Indianapolis, Ind

JAMA. 1995;274(21):1672.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Two points of concern in the article by Dr Guest and colleagues¹ on detecting myocardial injury in critically ill patients using cardiac troponin I raise doubts about the usefulness of this study.

First, in the "Methods" section the authors state, "Patients who met criteria for cardiac injury based on cardiac troponin I levels who were not diagnosed with acute myocardial infarction by the ICU [intensive care unit] team were classified as having unrecognized myocardial injury. Diagnoses of acute infarction made by the ICU team that were not confirmed by elevated levels of cardiac troponin I were considered false-positive diagnoses." This operational definition of myocardial injury implies two conclusions: that cardiac troponin I is 100% sensitive and 100% specific and/or that clinicians at the institution have difficulty diagnosing myocardial infarction using currently established tools (by diagnosing myocardial infarction in four patients in whom cardiac troponin I was . . . [Full Text PDF of this Article]

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