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Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome
- Source :
- Chapman, A R, Lee, K K, McAllister, D A, Cullen, L, Greenslade, J H, Parsonage, W, Worster, A, Kavsak, P A, Blankenberg, S, Neumann, J, Söerensen, N A, Westermann, D, Buijs, M M, Verdel, G J E, Pickering, J W, Than, M P, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, F E, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, F K, Metkus, T S, Sandoval, Y, Apple, F S, Newby, D E, Shah, A S V & Mills, N L 2017, ' Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome ', Journal of the American Medical Association (JAMA), vol. 318, no. 19, pp. 1913-1924 . https://doi.org/10.1001/jama.2017.17488, Chapman, A R, Lee, K K, McAllister, D A, Cullen, L, Greenslade, J H, Parsonage, W, Worster, A, Kavsak, P A, Blankenberg, S, Neumann, J, Söerensen, N A, Westermann, D, Buijs, M M, Verdel, G J E, Pickering, J W, Than, M P, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, F E, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, F K, Metkus, T S, Sandoval, Y, Apple, F S, Newby, D E, Shah, A S V & Mills, N L 2018, ' Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome ', JAMA, vol. 318, no. 19, pp. 1913-1924 . https://doi.org/10.1001/jama.2017.17488
- Publication Year :
- 2017
-
Abstract
- Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain.Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017.Study Selection: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction.Data Extraction and Synthesis: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model.Main Outcomes and Measures: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data.Results: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death.Conclusions and Relevance: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification.
- Subjects :
- Adult
Male
medicine.medical_specialty
Acute coronary syndrome
Myocardial Infarction
Review
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Internal medicine
Troponin I
medicine
Journal Article
Humans
030212 general & internal medicine
Myocardial infarction
Prospective Studies
Acute Coronary Syndrome
Prospective cohort study
biology
business.industry
General Medicine
medicine.disease
Prognosis
Troponin
Death
Meta-analysis
biology.protein
Cardiology
Myocardial infarction diagnosis
Risk assessment
business
Biomarkers
Meta-Analysis
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Chapman, A R, Lee, K K, McAllister, D A, Cullen, L, Greenslade, J H, Parsonage, W, Worster, A, Kavsak, P A, Blankenberg, S, Neumann, J, Söerensen, N A, Westermann, D, Buijs, M M, Verdel, G J E, Pickering, J W, Than, M P, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, F E, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, F K, Metkus, T S, Sandoval, Y, Apple, F S, Newby, D E, Shah, A S V & Mills, N L 2017, ' Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome ', Journal of the American Medical Association (JAMA), vol. 318, no. 19, pp. 1913-1924 . https://doi.org/10.1001/jama.2017.17488, Chapman, A R, Lee, K K, McAllister, D A, Cullen, L, Greenslade, J H, Parsonage, W, Worster, A, Kavsak, P A, Blankenberg, S, Neumann, J, Söerensen, N A, Westermann, D, Buijs, M M, Verdel, G J E, Pickering, J W, Than, M P, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, F E, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, F K, Metkus, T S, Sandoval, Y, Apple, F S, Newby, D E, Shah, A S V & Mills, N L 2018, ' Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome ', JAMA, vol. 318, no. 19, pp. 1913-1924 . https://doi.org/10.1001/jama.2017.17488
- Accession number :
- edsair.doi.dedup.....fbd6bc99aab2ab9ba9afb0964bd3ba14