**7. Conclusions**

This chapter summarises the extensive literature base examining the clinical utility of cardiac troponin when tested in the postmortem setting. Whilst there is overwhelming evidence to support the superior value of pericardial fluid cTn rather than blood sampling due to significant interferences with the latter, there remains the issue of clinically validated cut-off concentrations in postmortem sampling. The effect of autolysis and increasing concentrations of cTn in fluid analysis correlated with increasing postmortem interval of significance. These features therefore suggest that cTn analysis is more suited as a rule out of cardiac involvement in sudden death rather than a rule in diagnostic aid. The diagnostic utility should be limited to the hospital autopsy rather than the medico-legal postmortem where these factors and interferences could provide scope for counter arguments by the defence counsel. Further work is required in the medico-legal setting to establish appropriate diagnostic cut-off values for cTnT and cTnI in postmortem samples, and clinical pathological guidelines should be written to provide support to the forensic teams to correctly interpret the evidence from this large selection of published literature.
