The early diagnostic and prognostic utility of high-sensitive troponin assays in acute myocardial infarction: a meta-analysis.
Intern Med J. 2014 Nov 18;
Authors: Li WJ, Chen XM, Nie XY, Lin XX, Cheng YJ, Hu CH, Du ZM, Dong YG, Ma H, Wu SH
OBJECTIVE: To determine the diagnostic and prognostic utility of high-sensitive troponin assays in very early phase of AMI (less than 3 hours since symptoms onset) by performing a meta-analysis of prospective studies.
DATA AND SOURCES: Relevant studies were identified by searches of MEDLINE and Elsevier Sciencedirect until January 31st, 2014 and by reviewing the reference lists from retrieved articles.
STUDY SELECTION: Prospective studies that reported diagnostic utility in AMI using both high-sensitive troponin assays and conventional cardiac troponin, and reported the estimates of hazard ratio (HR) with 95% confidence intervals (CIs) for prognostic utility were included.
DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two authors and summary estimates of association were obtained using a random-effects model.
RESULTS: Of the 7 studies included, 4 studies reported the diagnostic utility of high-sensitive troponin assays (2863 Patients) and 3 reported the prognostic utility in AMI (2329 Patients). Within 12 hours since the symptoms onset, the pooled sensitivity and specificity of high-sensitive troponin assays were 0.89 (95%CI 0.85-0.91) and 0.89 (95%CI 0.85-0.92), respectively, and within 3 hours the pooled sensitivity and specificity of high-sensitive troponin assays were 0.79 (95%CI 0.71-0.85) and 0.92 (95%CI 0.88-0.96), respectively. Compared with conventional cardiac troponin assays, the high-sensitive troponin assays had higher sensitivity (0.89 vs 0.72) but lower specificity (0.89 vs 0.95) in diagnosing AMI within 12 hours since the symptoms onset. Within 3 hours, the sensitivity of high-sensitive troponin assays was still higher (0.79 vs 0.59), but the specificity was almost the same (0.92 vs 0.95) as which of conventional troponin assays. The elevated high-sensitive troponin assays had an overall pooled HRs of 2.66 (95%CI 1.31-5.44) and 2.14 (95%CI 1.15-3.98) for the endpoints of death and non-fatal AMI, respectively.
CONCLUSIONS: These findings provide quantitative data supporting that the high-sensitive troponin assays have early diagnostic and prognostic utility in AMI.
PMID: 25403852 [PubMed - as supplied by publisher]