Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome Academic Article uri icon

  •  
  • Overview
  •  
  • Research
  •  
  • Identity
  •  
  • Additional Document Info
  •  
  • View All
  •  

abstract

  • Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain. Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome. Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017. Study Selection: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction. Data Extraction and Synthesis: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model. Main Outcomes and Measures: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data. Results: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death. Conclusions and Relevance: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification.

authors

  • Chapman, Andrew R
  • Lee, Kuan Ken
  • McAllister, David A
  • Cullen, Louise
  • Greenslade, Jaimi H
  • Parsonage, William
  • Worster, Andrew
  • Kavsak, Peter
  • Blankenberg, Stefan
  • Neumann, Johannes
  • Sörensen, Nils A
  • Westermann, Dirk
  • Buijs, Madelon M
  • Verdel, Gerard JE
  • Pickering, John W
  • Than, Martin P
  • Twerenbold, Raphael
  • Badertscher, Patrick
  • Sabti, Zaid
  • Mueller, Christian
  • Anand, Atul
  • Adamson, Philip
  • Strachan, Fiona E
  • Ferry, Amy
  • Sandeman, Dennis
  • Gray, Alasdair
  • Body, Richard
  • Keevil, Brian
  • Carlton, Edward
  • Greaves, Kim
  • Korley, Frederick K
  • Metkus, Thomas S
  • Sandoval, Yader
  • Apple, Fred S
  • Newby, David E
  • Shah, Anoop SV
  • Mills, Nicholas L

publication date

  • November 21, 2017