Second look: The predictive value of elevated cardiac troponins often depends on re-testing.

: We read with interest the paper by Wang et al who find a low incidence of cardiac events in a cohort of elderly patients with unspecific complaints and elevated cardiac troponin I levels. Elevation of cardiac troponins may be caused by a wide variety of conditions other than myocardial ischemia. Chronic renal failure (surprisingly absent in this study), tachycardia and myocardial hypertrophy are among the most prominent. Even if unspecific as to the cause of elevation, higher levels of cardiac troponins are associated with worse outcome in different settings such as mayor surgery or systemic disease.