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Troponin-Based Risk Stratification of Patients With Acute Nonmassive Pulmonary Embolism: Systematic Review and Metaanalysis.
Chest. 2009 May 22;
Authors: Jiménez D, Uresandi F, Otero R, Lobo JL, Monreal M, Martí D, Zamora J, Muriel A, Aujesky D, Yusen RD
Data synthesis From the literature search, 596 publications were screened. Nine studies that consisted of 1366 normotensive patients with acute symptomatic PE were deemed eligible. Pooled results showed that elevated troponin levels were associated with a 4.26-fold increased odds of overall mortality [95%confidence interval (CI) 2.13 to 8.50, heterogeneity chi = 12.64, df = 8, p = 0.125]. Summary receiver operating characteristic (SROC) curve analysis showed a relationship between sensitivity and specificity of troponin levels to predict overall mortality [Spearman rank correlation coefficient = 0.68 (p = 0.046)]. Pooled likelihood ratios were not extreme [negative likelihood ratio 0.59 (95%CI 0.39 to 0.88), and positive likelihood ratio 2.26 (95%CI 1.66 to 3.07)]. The Begg rank correlation method did not detect evidence of publication bias. Conclusions This metaanalysis indicates that elevated troponin levels do not adequately discern normotensive patients with acute symptomatic PE at high from those at low-risk for death.
PMID: 19465511 [PubMed - as supplied by publisher]