We are pleased to provide a response to the letter to the Editor entitled “Cut-off for High-Sensitivity Cardiac Troponin T Not Arbitrarily but Accordingly to Usual Clinical Practice,” regarding our article previously published in the Journal. In this letter to the Editor, Cubero Gallego and colleagues raised several important issues related to the combination of biomarkers with electrocardiographic (ECG) or transthoracic echocardiographic criteria to diagnose perioperative myocardial infarction (MI), the mechanism of perioperative MI after heart valve surgery, and the requirement of a stable baseline of high-sensitivity cardiac troponin T (hs-cTnT) before surgery to distinguish an acute event from a recent index MI.
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