The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis
P A Heidenreich1, T Alloggiamento, K Melsop
1Veterans Affairs Palo Alto Health Care System, California 94304, USA. heiden@stanford.edu
Insights
An abnormal troponin test in non-ST elevation acute coronary syndromes (ACS) significantly increases short-term death risk threefold to eightfold. Cohort studies show higher prognostic value for troponin compared to clinical trials.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Trials
Background:
- Accurate risk stratification is crucial for managing patients with suspected acute coronary syndromes (ACS).
- Determining appropriate hospitalization and treatment intensity relies on effective risk assessment.
Purpose of the Study:
- To compare the prognostic significance of abnormal troponin levels in non-ST elevation ACS.
- To evaluate troponin's predictive value for mortality in ACS patients.
Main Methods:
- Systematic review of clinical trials and cohort studies (1966-1999) on non-ST elevation ACS.
- Inclusion criteria: consecutive patients, troponin results, and mortality data.
- Exclusion criteria: studies limited to acute myocardial infarction or lacking troponin/mortality data.
Main Results:
- Data from 7 trials and 19 cohort studies involving 5,360 (troponin T) and 6,603 (troponin I) patients.
- Positive troponin (I or T) associated with significantly higher mortality (5.2% vs. 1.6%, OR 3.1).
- Cohort studies showed greater mortality differences for troponin I (OR 8.5) and troponin T (OR 5.1) compared to clinical trials (OR 2.6 and 3.0, respectively).
Conclusions:
- Abnormal troponin tests in non-ST elevation ACS increase short-term mortality odds significantly (3- to 8-fold).
- Troponin demonstrates higher prognostic value in cohort studies than in clinical trials for predicting mortality.
Objectives:
This study was designed to compare the prognostic value of an abnormal troponin level derived from studies of patients with non-ST elevation acute coronary syndromes (ACS).
Background:
Risk stratification for patients with suspected ACS is important for determining need for hospitalization and intensity of treatment.
Methods:
We identified clinical trials and cohort studies of consecutive patients with suspected ACS without ST-elevation from 1966 through 1999. We excluded studies limited to patients with acute myocardial infarction and studies not reporting mortality or troponin results.
Results:
Seven clinical trials and 19 cohort studies reported data for 5,360 patients with a troponin T test and 6,603 with a troponin I test. Patients with positive troponin (I or T) had significantly higher mortality than those with a negative test (5.2% vs. 1.6%, odds ratio [OR] 3.1). Cohort studies demonstrated a greater difference in mortality between patients with a positive versus negative troponin I (8.4% vs. 0.7%, OR 8.5) than clinical trials (4.8% if positive, 2.1% if negative, OR 2.6, p = 0.01). Prognostic value of a positive troponin T was also slightly greater for cohort studies (11.6% mortality if positive, 1.7% if negative, OR 5.1) than for clinical trials (3.8% if positive, 1.3% if negative, OR 3.0, p = 0.2)
Conclusions:
In patients with non-ST elevation ACS, the short-term odds of death are increased three- to eightfold for patients with an abnormal troponin test. Data from clinical trials suggest a lower prognostic value for troponin than do data from cohort studies.
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