TY - JOUR
T1 - Comparison of conventional and high-sensitivity troponin in patients with chest pain
T2 - A collaborative meta-analysis
AU - Lipinski, Michael J.
AU - Baker, Nevin C.
AU - Escárcega, Ricardo O.
AU - Torguson, Rebecca
AU - Chen, Fang
AU - Aldous, Sally J.
AU - Christ, Michael
AU - Collinson, Paul O.
AU - Goodacre, Steve W.
AU - Mair, Johannes
AU - Inoue, Kenji
AU - Lotze, Ulrich
AU - Sebbane, Mustapha
AU - Cristol, Jean Paul
AU - Freund, Yonathan
AU - Chenevier-Gobeaux, Camille
AU - Meune, Christophe
AU - Eggers, Kai M.
AU - Pracoń, Radosław
AU - Schreiber, Donald H.
AU - Wu, Alan H.B.
AU - Ordõez-Llanos, Jordi
AU - Jaffe, Allan S.
AU - Twerenbold, Raphael
AU - Mueller, Christian
AU - Waksman, Ron
N1 - Publisher Copyright:
© 2014 Elsevier Inc. All rights reserved.
PY - 2015/1
Y1 - 2015/1
N2 - Background Multiple studies have evaluated the diagnostic and prognostic performance of conventional troponin (cTn) and high-sensitivity troponin (hs-cTn). We performed a collaborative meta-analysis comparing cTn and hs-cTn for diagnosis of acute myocardial infarction (AMI) and assessment of prognosis in patients with chest pain. Methods MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing both cTn and hscTn in patients with chest pain. Study authors were contacted and many provided previously unpublished data. Results From 17 included studies, there were 8,644 patients. Compared with baseline cTn, baseline hs-cTn had significantly greater sensitivity (0.884 vs 0.749, P b .001) and negative predictive value (NPV; 0.964 vs 0.935, P b .001), whereas specificity (0.816 vs 0.938, P b .001) and positive predictive value (0.558 vs 0.759, P b .001) were significantly reduced. Based on summary receiver operating characteristic curves, test performance for the diagnosis of AMI was not significantly different between baseline cTn and hs-cTn (0.90 [95% CI 0.85-0.95] vs 0.92 [95% CI 0.90-0.94]). In a subanalysis of 6 studies that alternatively defined AMI based on hs-cTn, cTn had lower sensitivity (0.666, P b .001) and NPV (0.906, P b .001). Elevation of baseline hs-cTn, but negative baseline cTn, was associated with increased risk of death or nonfatal myocardial infarction during follow-up (P b .001) compared with both negative. Conclusion High-sensitivity troponin has significantly greater early sensitivity and NPV for the diagnosis of AMI at the cost of specificity and positive predictive value, which may enable early rule in/out of AMI in patients with chest pain. Baseline hs-cTn elevation in the setting of negative cTn is also associated with increased nonfatal myocardial infarction or death during follow-up.
AB - Background Multiple studies have evaluated the diagnostic and prognostic performance of conventional troponin (cTn) and high-sensitivity troponin (hs-cTn). We performed a collaborative meta-analysis comparing cTn and hs-cTn for diagnosis of acute myocardial infarction (AMI) and assessment of prognosis in patients with chest pain. Methods MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing both cTn and hscTn in patients with chest pain. Study authors were contacted and many provided previously unpublished data. Results From 17 included studies, there were 8,644 patients. Compared with baseline cTn, baseline hs-cTn had significantly greater sensitivity (0.884 vs 0.749, P b .001) and negative predictive value (NPV; 0.964 vs 0.935, P b .001), whereas specificity (0.816 vs 0.938, P b .001) and positive predictive value (0.558 vs 0.759, P b .001) were significantly reduced. Based on summary receiver operating characteristic curves, test performance for the diagnosis of AMI was not significantly different between baseline cTn and hs-cTn (0.90 [95% CI 0.85-0.95] vs 0.92 [95% CI 0.90-0.94]). In a subanalysis of 6 studies that alternatively defined AMI based on hs-cTn, cTn had lower sensitivity (0.666, P b .001) and NPV (0.906, P b .001). Elevation of baseline hs-cTn, but negative baseline cTn, was associated with increased risk of death or nonfatal myocardial infarction during follow-up (P b .001) compared with both negative. Conclusion High-sensitivity troponin has significantly greater early sensitivity and NPV for the diagnosis of AMI at the cost of specificity and positive predictive value, which may enable early rule in/out of AMI in patients with chest pain. Baseline hs-cTn elevation in the setting of negative cTn is also associated with increased nonfatal myocardial infarction or death during follow-up.
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U2 - 10.1016/j.ahj.2014.10.007
DO - 10.1016/j.ahj.2014.10.007
M3 - Review article
C2 - 25497242
AN - SCOPUS:84921900997
SN - 0002-8703
VL - 169
SP - 6-16.e6
JO - American heart journal
JF - American heart journal
IS - 1
ER -