BACKGROUND: Use of high-sensitivity troponin (hs-Tn) assays can detect small levels of myocardial damage previously undetectable with conventional troponin (c-Tn) assays. However, prognostic utility of these hs-Tn assays in prediction of mortality remains unclear in the presence of nonelevated c-Tn levels on admission. A systematic review and meta-analysis was performed to assess mortality risk of patients with hs-Tn elevations in the setting of normal c-Tn levels. HYPOTHESIS: Patients with hs-Tn elevations with normal c-Tn levels on admission blood samples, drawn to rule out acute coronary syndrome (ACS), have a higher mortality risk than those without hs-Tn or c-Tn elevations. METHODS: A search was made of the PubMed, CENTRAL, EMBASE, CINAHL, EBSCO, and Web of Science databases. Studies evaluating patients with suspected ACS that reported mortality rates for those with elevated hs-Tn levels but normal c-Tn levels on admission were included. A random-effects model was used to pool event rates, and data were reported in odds ratios (95% confidence interval). RESULTS: Four studies (N = 2033, mean age 64-75 years, 49%-70% male) revealed that nearly 32% of suspected ACS patients with normal c-Tn levels on admission had elevated hs-Tn levels. Elevated hs-Tn levels conferred a significantly higher risk of all-cause mortality vs normal hs-Tn levels (odds ratio: 4.35, 95% confidence interval: 2.81-6.73, P < 0.01), with negligible heterogeneity (I(2) = 0%). CONCLUSIONS: Elevation of hs-Tn levels predicted a higher risk of mortality in patients with suspected ACS and may aid in the early identification of higher-risk patients in this setting. Future studies are needed to investigate further optimal management strategies.
BACKGROUND: Use of high-sensitivity troponin (hs-Tn) assays can detect small levels of myocardial damage previously undetectable with conventional troponin (c-Tn) assays. However, prognostic utility of these hs-Tn assays in prediction of mortality remains unclear in the presence of nonelevated c-Tn levels on admission. A systematic review and meta-analysis was performed to assess mortality risk of patients with hs-Tn elevations in the setting of normal c-Tn levels. HYPOTHESIS: Patients with hs-Tn elevations with normal c-Tn levels on admission blood samples, drawn to rule out acute coronary syndrome (ACS), have a higher mortality risk than those without hs-Tn or c-Tn elevations. METHODS: A search was made of the PubMed, CENTRAL, EMBASE, CINAHL, EBSCO, and Web of Science databases. Studies evaluating patients with suspected ACS that reported mortality rates for those with elevated hs-Tn levels but normal c-Tn levels on admission were included. A random-effects model was used to pool event rates, and data were reported in odds ratios (95% confidence interval). RESULTS: Four studies (N = 2033, mean age 64-75 years, 49%-70% male) revealed that nearly 32% of suspected ACS patients with normal c-Tn levels on admission had elevated hs-Tn levels. Elevated hs-Tn levels conferred a significantly higher risk of all-cause mortality vs normal hs-Tn levels (odds ratio: 4.35, 95% confidence interval: 2.81-6.73, P < 0.01), with negligible heterogeneity (I(2) = 0%). CONCLUSIONS: Elevation of hs-Tn levels predicted a higher risk of mortality in patients with suspected ACS and may aid in the early identification of higher-risk patients in this setting. Future studies are needed to investigate further optimal management strategies.
Authors: E M Antman; M Cohen; P J Bernink; C H McCabe; T Horacek; G Papuchis; B Mautner; R Corbalan; D Radley; E Braunwald Journal: JAMA Date: 2000-08-16 Impact factor: 56.272
Authors: H Benamer; P G Steg; J Benessiano; E Vicaut; C J Gaultier; P Aubry; O Boudvillain; L Sarfati; E Brochet; L J Feldman; D Himbert; J M Juliard; P Assayag Journal: Am Heart J Date: 1999-05 Impact factor: 4.749
Authors: D A Morrow; E M Antman; M Tanasijevic; N Rifai; J A de Lemos; C H McCabe; C P Cannon; E Braunwald Journal: J Am Coll Cardiol Date: 2000-11-15 Impact factor: 24.094
Authors: L K Newby; E M Ohman; R H Christenson; D J Moliterno; R A Harrington; H D White; P W Armstrong; F Van De Werf; M Pfisterer; V Hasselblad; R M Califf; E J Topol Journal: Circulation Date: 2001-06-19 Impact factor: 29.690
Authors: D F Stroup; J A Berlin; S C Morton; I Olkin; G D Williamson; D Rennie; D Moher; B J Becker; T A Sipe; S B Thacker Journal: JAMA Date: 2000-04-19 Impact factor: 56.272
Authors: Adnan Kastrati; Julinda Mehilli; Franz-Josef Neumann; Franz Dotzer; Jurriën ten Berg; Hildegard Bollwein; Isolde Graf; Maryam Ibrahim; Jürgen Pache; Melchior Seyfarth; Helmut Schühlen; Josef Dirschinger; Peter B Berger; Albert Schömig Journal: JAMA Date: 2006-03-13 Impact factor: 56.272