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Meta-Analysis
. 2015 Jan;169(1):6-16.e6.
doi: 10.1016/j.ahj.2014.10.007. Epub 2014 Oct 22.

Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis

Michael J Lipinski  1 , Nevin C Baker  1 , Ricardo O Escárcega  1 , Rebecca Torguson  1 , Fang Chen  1 , Sally J Aldous  2 , Michael Christ  3 , Paul O Collinson  4 , Steve W Goodacre  5 , Johannes Mair  6 , Kenji Inoue  7 , Ulrich Lotze  8 , Mustapha Sebbane  9 , Jean-Paul Cristol  10 , Yonathan Freund  11 , Camille Chenevier-Gobeaux  12 , Christophe Meune  13 , Kai M Eggers  14 , Radosław Pracoń  15 , Donald H Schreiber  16 , Alan H B Wu  17 , Jordi Ordoñez-Llanos  18 , Allan S Jaffe  19 , Raphael Twerenbold  20 , Christian Mueller  21 , Ron Waksman  22
Affiliations
Meta-Analysis

Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis

Michael J Lipinski et al. Am Heart J. 2015 Jan.

Abstract

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 Study authors were contacted and many provided previously unpublished data.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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