Comparison of conventional and high-sensitivity troponin in patients with chest pain: A collaborative meta-analysis

• Published in: The American heart journal Vol. 169; no. 1; pp. 6 - 16.e6
• Main Authors: Lipinski, Michael J., MD, PhD, Baker, Nevin C., DO, Escárcega, Ricardo O., MD, Torguson, Rebecca, MPH, Chen, Fang, PhD, Aldous, Sally J., MBChB, MD, Christ, Michael, MD, Collinson, Paul O., MD, FRCPath, Goodacre, Steve W., PhD, Mair, Johannes, MD, Inoue, Kenji, MD, PhD, Lotze, Ulrich, MD, Sebbane, Mustapha, MD, PhD, Cristol, Jean-Paul, MD, PhD, Freund, Yonathan, MD, Chenevier-Gobeaux, Camille, PharmD, PhD, Meune, Christophe, MD, PhD, Eggers, Kai M., MD, PhD, Pracoń, Radosław, MD, Schreiber, Donald H., MD, Wu, Alan H.B., PhD, Ordoñez-Llanos, Jordi, MD, PhD, Jaffe, Allan S., MD, Twerenbold, Raphael, MD, Mueller, Christian, MD, Waksman, Ron, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2015; Elsevier Limited; Elsevier
• Subjects: Acute coronary syndromes; Cardiology and cardiovascular system; Cardiovascular; Cardiovascular disease; Chest Pain - blood; Chest Pain - etiology; Heart attacks; Human health and pathology; Humans; Hypothesis testing; Life Sciences; Meta-analysis; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Prognosis; ROC Curve; Santé publique et épidémiologie; Sensitivity and Specificity; Studies; Troponin - blood
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2014.10.007

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 hs-cTn 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 Study authors were contacted and many provided previously unpublished data.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 < .001) and negative predictive value (NPV; 0.964 vs 0.935, P < .001), whereas specificity (0.816 vs 0.938, P < .001) and positive predictive value (0.558 vs 0.759, P < .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 < .001) and NPV (0.906, P < .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 < .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.