Increased level of high-sensitivity cardiac troponin T in a geriatric population is determined by comorbidities compared to age

The introduction of high-sensitivity cardiac troponin (hs-cTn) and its analytical superiority translated within the last years into a clinical superiority in the early diagnosis of acute myocardial infarction (AMI) [1][2][3].This superiority allows, the rapid identification of AMI especially among groups of patients with atypical signs and symptoms as elderly.In patients presenting with suspected AMI, beyond the presence or absence of MI, four clinical variables seem to impact on hs-cTn concentrations: age, sex, renal dysfunction, and time from chest pain onset [4][5][6][7][8][9][10].Current guidelines still recommend the use of one uniform cutoff level for all patients [1].However, the diagnostic accuracy of hs-cTn in the elderly is uncertain, as elevated levels of hs-cTn were found in up to 50% of patients at the emergency department (ED) with diagnosis other than AMI, making the appropriate interpretation of hs-cTn among these patients even more challenging [7].Reasons for higher hs-cTn levels among elderly include acute and chronic disorders also associated with low-level myocardial necrosis, since rhythm disorders, heart failure, and impaired renal function are very common among these patients [7].In this issue of the Journal, the important observations reported by Mahdi Sedeghi and colleagues [11] are yet another important piece in the puzzle of hs-cTn among elderly.Among this large cohort (n = 6977) of patients over 65 years old presenting to the ED with suspected AMI and having different diagnoses other than acute coronary syndromes (ACS), hs-cTn levels and clinical data were collected.Their analyses found that the likelihood of increased hs-cTnT levels was related to