The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis
Key result
Positive troponin linked to ~210% higher short-term mortality in NSTE-ACS versus a negative test.
- OR 3.1
- n=11,963
Why the study?
Risk stratification for patients with suspected ACS is important for determining need for hospitalization and intensity of treatment, prompting a comparison of the prognostic value of abnormal troponin levels.
Does a positive troponin test predict short-term mortality in patients with non-ST elevation acute coronary syndromes?
Comparison
Positive troponin (I or T) vs negative troponin test
Design
Meta-analysis of clinical trials and cohort studies
Follow-up
Short-term
Authors
Discussion
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Member takes
Implication
Supports troponin for NSTE-ACS prognostication; leaves open whether it should guide contemporary therapy.
Key Points
- To evaluate and compare the prognostic significance of abnormal troponin I and troponin T levels for predicting mortality in patients presenting with non-ST elevation acute coronary syndromes.
- Conducted a systematic review and meta-analysis of clinical trials and cohort studies published between 1966 and 1999 evaluating consecutive patients with suspected non-ST elevation acute coronary syndromes.
- Included 7 clinical trials and 19 cohort studies encompassing 5,360 patients with a troponin T assay and 6,603 patients with a troponin I assay, excluding studies limited solely to acute myocardial infarction.
- Patients with a positive troponin (I or T) test had significantly higher mortality than those with a negative test (5.2% vs. 1.6%; OR 3.1).
- Cohort studies demonstrated a significantly higher mortality difference for positive versus negative troponin I (8.4% vs. 0.7%; OR 8.5) compared to clinical trials (4.8% vs. 2.1%; OR 2.6; p = 0.01).
- Troponin T positivity was also associated with increased mortality risk in cohort studies (11.6% vs. 1.7%; OR 5.1) and clinical trials (3.8% vs. 1.3%; OR 3.0; p = 0.2).
Study Design
Type
Meta-Analysis (n=11,963)
Structured PICO
Does a positive troponin test predict short-term mortality in patients with non-ST elevation acute coronary syndromes?
P
Population
11,963 patients with suspected non-ST elevation acute coronary syndromes from 7 clinical trials and 19 cohort studies, assessing short-term mortality.
E
Exposure
Positive troponin (I or T) test
C
Comparator
Negative troponin (I or T) test
O
Outcome
Short-term mortalityhard clinical
Main Result
Odds Ratio: 3.1
Absolute Event Rate: 5.2% vs 1.6%
An abnormal troponin test in patients with non-ST elevation ACS is associated with a three- to eightfold increased odds of short-term death, with cohort studies showing a stronger prognostic value than clinical trials.
Cite This Study
Heidenreich et al. (2001) conducted a meta-analysis in non-ST elevation acute coronary syndromes (n=11,963). Positive troponin (I or T) vs. Negative troponin was evaluated on Mortality (OR 3.1). In patients with non-ST elevation ACS, a positive troponin test was associated with significantly higher short-term mortality compared to a negative test (5.2% vs. 1.6%, OR 3.1).