Key result
Elevated cardiac troponin I and T in suspected acute coronary syndrome without ST elevation increased the risk of 30-day death and myocardial infarction (OR 4.9; 95% CI 3.9-6.2 for cTnI).
Why the study?
Do elevated cardiac troponin I and T levels predict adverse events in patients with acute coronary syndrome without ST elevation?
Meta-Analysis
Do elevated cardiac troponin I and T levels predict adverse events in patients with acute coronary syndrome without ST elevation?
Elevated cardiac troponin I and T are strong, comparable predictors of 30-day death and myocardial infarction in patients with non-ST elevation acute coronary syndrome, especially when sampled at least 6 hours after symptom onset.
Elevated troponins identify higher-risk NSTE-ACS patients for intensified management; reinforces their role in guideline-directed risk stratification.
We performed a meta-analysis of published trials to determine the predictive value of cardiac troponin I (cTnI) and T (cTnT) levels for adverse events (death and myocardial infarction) in acute coronary syndrome without ST elevation (ACS). The accumulated odds ratio (OR) for adverse events (30 days) in ACS with elevated cTnI (n = 5,759) and cTnT (n = 5,483) was 4.9 (95% confidence interval, CI, 3.9-6.2) and 4.6 (95% CI 3.8-5.5), respectively. Trials that mandated timed serum sampling (6 or more hours after symptom onset) had an improved predictive value for elevated cTnI (n = 2,807, OR 8.8; 95% CI 5.9-13.2) and cTnT (n = 1,990, OR 8.5; 95% CI 5.9-12.5). In conclusion, cTnI and cTnT provide similar information in ACS. The risk of adverse events is 4-fold higher in patients with suspected ACS and elevated serum cTn. For patients with an elevated timed (6-hour) sample the risk is over 8-fold higher.
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Fleming et al. (2001) conducted a meta-analysis in Acute coronary syndrome without ST elevation. Elevated cardiac troponin I (cTnI) and T (cTnT) vs. Non-elevated cardiac troponin was evaluated on Adverse events (death and myocardial infarction) at 30 days (OR 4.9, 95% CI 3.9-6.2). Elevated cardiac troponin I and T in suspected acute coronary syndrome without ST elevation increased the risk of 30-day death and myocardial infarction (OR 4.9; 95% CI 3.9-6.2 for cTnI).
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