Key result
Elevated high-sensitivity troponin linked to ~4.3-fold higher mortality risk despite normal conventional troponin.
Why the study?
Does elevated high-sensitivity troponin on admission predict higher mortality in patients with suspected ACS and normal conventional troponin?
Meta-Analysis (n=2,033)
Does elevated high-sensitivity troponin on admission predict higher mortality in patients with suspected ACS and normal conventional troponin?
Odds Ratio: 4.35 (95% CI 2.81–6.73)
Absolute Event Rate: 9.7% vs 2.5%
p-value: p=<0.01
Elevated high-sensitivity troponin in suspected ACS patients with normal conventional troponin identifies a vulnerable subgroup with a more than 4-fold increase in short- and long-term mortality.
May improve risk stratification in suspected ACS with normal c-Tn; leaves open whether hs-Tn-guided interventions reduce mortality.
BACKGROUND: Use of high-sensitivity troponin (hs-Tn) assays can detect small levels of myocardial damage previously undetectable with conventional troponin (c-Tn) assays. However, prognostic utility of these hs-Tn assays in prediction of mortality remains unclear in the presence of nonelevated c-Tn levels on admission. A systematic review and meta-analysis was performed to assess mortality risk of patients with hs-Tn elevations in the setting of normal c-Tn levels. HYPOTHESIS: Patients with hs-Tn elevations with normal c-Tn levels on admission blood samples, drawn to rule out acute coronary syndrome (ACS), have a higher mortality risk than those without hs-Tn or c-Tn elevations. METHODS: A search was made of the PubMed, CENTRAL, EMBASE, CINAHL, EBSCO, and Web of Science databases. Studies evaluating patients with suspected ACS that reported mortality rates for those with elevated hs-Tn levels but normal c-Tn levels on admission were included. A random-effects model was used to pool event rates, and data were reported in odds ratios (95% confidence interval). RESULTS: Four studies (N = 2033, mean age 64-75 years, 49%-70% male) revealed that nearly 32% of suspected ACS patients with normal c-Tn levels on admission had elevated hs-Tn levels. Elevated hs-Tn levels conferred a significantly higher risk of all-cause mortality vs normal hs-Tn levels (odds ratio: 4.35, 95% confidence interval: 2.81-6.73, P < 0.01), with negligible heterogeneity (I(2) = 0%). CONCLUSIONS: Elevation of hs-Tn levels predicted a higher risk of mortality in patients with suspected ACS and may aid in the early identification of higher-risk patients in this setting. Future studies are needed to investigate further optimal management strategies.
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Chatterjee et al. (2013) conducted a meta-analysis in Suspected acute coronary syndrome with normal conventional troponin (n=2,033). Elevated high-sensitivity troponin on admission vs. Normal high-sensitivity troponin on admission was evaluated on All-cause mortality at 30 days or longer (OR 4.35, 95% CI 2.81-6.73, p=<0.01). In patients with suspected acute coronary syndrome and normal conventional troponin, elevated high-sensitivity troponin levels were associated with a significantly higher risk of all-cause mortality (OR 4.35).
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