© American Society for Clinical Pathology AJCP / Editorial Refining Our Criteria A Critical Challenge

raises a variety of issues that are key to the implementation of the universal definition of myocardial infarction (AMI).2-4 The group from Catalonia, Spain, evaluated a strategy using a contemporary, not an ultrasensitive, cardiac troponin (cTn) assay from Siemens Healthcare Diagnostics (Tarrytown, NY) in 284 consecutive patients. They applied criteria for AMI using the old iteration of the Bayer assay (Bayer, Tarrytown, NY) and a set of criteria using values above the 99th percen-tile with the newer, more sensitive TnI-Ultra assay in associa-tion with a 20 % change. They reported an ability to diagnose 66 additional episodes of acute myocardial injury with this approach. This is slightly more than half of the 109 times that they observed values above the 99th percentile. They suggest that this approach increased their specificity for diagnosing acute cardiac injury. Furthermore, they thought clinically tha