Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis
Michael J Lipinski1, Nevin C Baker1, Ricardo O Escárcega1
1MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC.
Insights
High-sensitivity troponin (hs-cTn) offers greater early sensitivity and negative predictive value for diagnosing acute myocardial infarction (AMI) compared to conventional troponin (cTn). However, hs-cTn shows reduced specificity and positive predictive value, impacting early AMI rule-out.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Testing
Background:
- Conventional troponin (cTn) and high-sensitivity troponin (hs-cTn) have been evaluated for acute myocardial infarction (AMI) diagnosis and prognosis.
- Studies comparing cTn and hs-cTn performance in patients with chest pain are numerous.
Purpose of the Study:
- To conduct a collaborative meta-analysis comparing cTn and hs-cTn for AMI diagnosis and prognosis.
- To assess the diagnostic and prognostic performance of both troponin assays.
Main Methods:
- A systematic literature search of MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE was performed.
- Included studies assessed both cTn and hs-cTn in patients presenting with chest pain.
- Previously unpublished data were obtained from study authors.
Main Results:
- In 8,644 patients from 17 studies, hs-cTn demonstrated significantly higher sensitivity (0.884 vs 0.749) and NPV (0.964 vs 0.935) than cTn.
- Specificity (0.816 vs 0.938) and PPV (0.558 vs 0.759) were significantly reduced with hs-cTn.
- hs-cTn elevation with negative cTn predicted increased risk of death or nonfatal myocardial infarction during follow-up.
Conclusions:
- High-sensitivity troponin offers improved early sensitivity and NPV for AMI diagnosis, aiding in early rule-in/rule-out decisions.
- The trade-off for improved sensitivity with hs-cTn includes reduced specificity and PPV.
- Elevated hs-cTn with a negative cTn result is a significant predictor of adverse cardiovascular events post-discharge.
Background:
Multiple studies have evaluated the diagnostic and prognostic performance of conventional troponin (cTn) and high-sensitivity troponin (hs-cTn). We performed a collaborative meta-analysis comparing cTn and hs-cTn for diagnosis of acute myocardial infarction (AMI) and assessment of prognosis in patients with chest pain.
Methods:
MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing both cTn and hs-cTn in patients with chest pain. Study authors were contacted and many provided previously unpublished data.
Results:
From 17 included studies, there were 8,644 patients. Compared with baseline cTn, baseline hs-cTn had significantly greater sensitivity (0.884 vs 0.749, P < .001) and negative predictive value (NPV; 0.964 vs 0.935, P < .001), whereas specificity (0.816 vs 0.938, P < .001) and positive predictive value (0.558 vs 0.759, P < .001) were significantly reduced. Based on summary receiver operating characteristic curves, test performance for the diagnosis of AMI was not significantly different between baseline cTn and hs-cTn (0.90 [95% CI 0.85-0.95] vs 0.92 [95% CI 0.90-0.94]). In a subanalysis of 6 studies that alternatively defined AMI based on hs-cTn, cTn had lower sensitivity (0.666, P < .001) and NPV (0.906, P < .001). Elevation of baseline hs-cTn, but negative baseline cTn, was associated with increased risk of death or nonfatal myocardial infarction during follow-up (P < .001) compared with both negative.
Conclusion:
High-sensitivity troponin has significantly greater early sensitivity and NPV for the diagnosis of AMI at the cost of specificity and positive predictive value, which may enable early rule in/out of AMI in patients with chest pain. Baseline hs-cTn elevation in the setting of negative cTn is also associated with increased nonfatal myocardial infarction or death during follow-up.
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