Comparison of conventional and high-sensitivity troponin in patients with chest pain: A collaborative meta-analysis - 10/12/14

Doi : 10.1016/j.ahj.2014.10.007

Michael J. Lipinski, MD, PhD ^a, Nevin C. Baker, DO ^a, Ricardo O. Escárcega, MD ^a, Rebecca Torguson, MPH ^a, Fang Chen, PhD ^a, Sally J. Aldous, MBChB, MD ^b, Michael Christ, MD ^c, Paul O. Collinson, MD, FRCPath ^d, Steve W. Goodacre, PhD ^e, Johannes Mair, MD ^f, Kenji Inoue, MD, PhD ^g, Ulrich Lotze, MD ^h, Mustapha Sebbane, MD, PhD ⁱ, Jean-Paul Cristol, MD, PhD ^j, Yonathan Freund, MD ^k, Camille Chenevier-Gobeaux, PharmD, PhD ^l, Christophe Meune, MD, PhD ^m,ⁿ, Kai M. Eggers, MD, PhD ^o, Radosław Pracoń, MD ^p, Donald H. Schreiber, MD ^q, Alan H.B. Wu, PhD ^r, Jordi Ordoñez-Llanos, MD, PhD ^s,^t, Allan S. Jaffe, MD ^u,^v, Raphael Twerenbold, MD ^w,^x, Christian Mueller, MD ^w, Ron Waksman, MD ^a,^{^⁎}
^a MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC
^b Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
^c Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuremberg, Germany
^d Clinical Blood Sciences Laboratory, St George's Hospital, London, United Kingdom
^e School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
^f Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria
^g Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
^h Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Frankenhausen, Germany
ⁱ Départment des urgences, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France
^j Département de Biochimie, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France
^k Department of Emergency Medicine and Surgery, Hôspital Pitié-Salpétrière, APHP, Université Pierre et Marie Curie-Paris 6 (UPMC), Paris, France
^l Clinical Chemistry Laboratory, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France
^m Cardiology Department, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France
ⁿ Cardiology Department, Paris XIII University, Avicenne Hospital, Bobigny, France
^o Department of Medical Sciences, Uppsala University, Uppsala, Sweden
^p Department of Coronary and Structural Heart Diseases, National Insititute of Cardiology, Warsaw, Poland
^q Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
^r Department of Laboratory Medicine, University of California, San Francisco, CA
^s Servei de Bioquímica Clínica, Hospital de Sant Pau, Barcelona, Spain
^t Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
^u Division of Cardiology, Mayo Clinic College of Medicine, Rochester, MN
^v Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN
^w Department of Cardiology, University Hospital Basel, Basel, Switzerland
^x Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany

^⁎Reprint requests: Ron Waksman, MD, MedStar Washington Hospital Center, 110 Irving St, NW, Suite 4B-1, Washington, DC 20010.

Résumé

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.

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Plan

Methods

Data sources and searches

Study selection

Data extraction and quality assessment

Data synthesis and analysis

Results

Diagnostic accuracy of cTn and hs-cTn

Meta-regression analysis

Subgroup analysis

AMI definition based on hs-cTn

cTn and hs-cTn for prognosis

Discussion

Conflicts of Interest/Disclosures

Funding: None.

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Comparison of conventional and high-sensitivity troponin in patients with chest pain: A collaborative meta-analysis - 10/12/14

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