Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review
Ankur Sethi,1 Anurag Bajaj,2 Gurveen Malhotra,1 Rohit R Arora,1 Sandeep Khosla1 1Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA; 2Department of Medicine, Wright Center of Graduate Medical Education, Scranton, PA, USA Back...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2014-07-01
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| Series: | Vascular Health and Risk Management |
| Online Access: | http://www.dovepress.com/diagnostic-accuracy-of-sensitive-or-high-sensitive-troponin-on-present-peer-reviewed-article-VHRM |
| _version_ | 1818448065335394304 |
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| author | Sethi A Bajaj A Malhotra G Arora RR Khosla S |
| author_facet | Sethi A Bajaj A Malhotra G Arora RR Khosla S |
| author_sort | Sethi A |
| collection | DOAJ |
| description | Ankur Sethi,1 Anurag Bajaj,2 Gurveen Malhotra,1 Rohit R Arora,1 Sandeep Khosla1 1Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA; 2Department of Medicine, Wright Center of Graduate Medical Education, Scranton, PA, USA Background: Recently, high-sensitive troponin (hsTrop) assays consistent with professional societies' recommendations became available. We aimed to summarize the evidence on the diagnostic accuracy of hsTrop on presentation. Methods: We searched electronic databases for studies evaluating the diagnostic accuracy of hsTrop in suspected acute coronary syndrome (ACS) patients. Random effect meta-analyses and meta-regression were performed. Primary and secondary analyses were restricted to studies using conventional Trop and hsTrop in the reference standard, respectively. Results: Fifteen studies with a total of 8,628 patients met the inclusion criteria for the primary analysis. hsTrop T (Hoffman-La Roche Ltd) and hsTrop I (Siemens) had sensitivities of 0.89 (95% confidence interval [CI]: 0.86–0.91) and 0.90 (95% CI: 0.87–0.92) and specificities of 0.79 (95% CI: 0.77–0.80) and 0.89 (95% CI: 0.87–0.90), respectively. There was no statistically significant difference in the area under the curve between hsTrop (95% CI: 0.920) and conventional Trop (95% CI: 0.929) at the 99th percentile (P=0.62). hsTrop at the level of detection had a sensitivity of 0.97 (95% CI: 0.96–0.98) and a specificity of 0.41 (95% CI: 0.40–0.42). The studies using a cut-off at coefficient of variance <10% as opposed to the 99th percentile for the conventional assay used for diagnosis reported higher diagnostic accuracy (relative diagnostic odds ratio =2.13, P=0.02). Five studies were included in the secondary analysis; hsTrop T (Hoffman-La Roche Ltd) had a sensitivity of 0.91 (95% CI: 0.89–0.93) and a specificity of 0.67 (95% CI: 0.63–0.70). There was significant heterogeneity among the studies. Conclusion: hsTrop have excellent diagnostic accuracy for myocardial infarction on presentation, but may not outperform conventional Trop assays. The variation among the studies can be explained, in part, by the cut-off used for conventional Trop assays. Keywords: high-sensitive troponin T, high-sensitive troponin I, sensitivity, specificity, level of detection |
| first_indexed | 2024-12-14T20:13:35Z |
| format | Article |
| id | doaj.art-cb2859e0a81b4729b575864263c7d0d0 |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-12-14T20:13:35Z |
| publishDate | 2014-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-cb2859e0a81b4729b575864263c7d0d02022-12-21T22:48:54ZengDove Medical PressVascular Health and Risk Management1178-20482014-07-012014default43545017674Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic reviewSethi ABajaj AMalhotra GArora RRKhosla SAnkur Sethi,1 Anurag Bajaj,2 Gurveen Malhotra,1 Rohit R Arora,1 Sandeep Khosla1 1Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA; 2Department of Medicine, Wright Center of Graduate Medical Education, Scranton, PA, USA Background: Recently, high-sensitive troponin (hsTrop) assays consistent with professional societies' recommendations became available. We aimed to summarize the evidence on the diagnostic accuracy of hsTrop on presentation. Methods: We searched electronic databases for studies evaluating the diagnostic accuracy of hsTrop in suspected acute coronary syndrome (ACS) patients. Random effect meta-analyses and meta-regression were performed. Primary and secondary analyses were restricted to studies using conventional Trop and hsTrop in the reference standard, respectively. Results: Fifteen studies with a total of 8,628 patients met the inclusion criteria for the primary analysis. hsTrop T (Hoffman-La Roche Ltd) and hsTrop I (Siemens) had sensitivities of 0.89 (95% confidence interval [CI]: 0.86–0.91) and 0.90 (95% CI: 0.87–0.92) and specificities of 0.79 (95% CI: 0.77–0.80) and 0.89 (95% CI: 0.87–0.90), respectively. There was no statistically significant difference in the area under the curve between hsTrop (95% CI: 0.920) and conventional Trop (95% CI: 0.929) at the 99th percentile (P=0.62). hsTrop at the level of detection had a sensitivity of 0.97 (95% CI: 0.96–0.98) and a specificity of 0.41 (95% CI: 0.40–0.42). The studies using a cut-off at coefficient of variance <10% as opposed to the 99th percentile for the conventional assay used for diagnosis reported higher diagnostic accuracy (relative diagnostic odds ratio =2.13, P=0.02). Five studies were included in the secondary analysis; hsTrop T (Hoffman-La Roche Ltd) had a sensitivity of 0.91 (95% CI: 0.89–0.93) and a specificity of 0.67 (95% CI: 0.63–0.70). There was significant heterogeneity among the studies. Conclusion: hsTrop have excellent diagnostic accuracy for myocardial infarction on presentation, but may not outperform conventional Trop assays. The variation among the studies can be explained, in part, by the cut-off used for conventional Trop assays. Keywords: high-sensitive troponin T, high-sensitive troponin I, sensitivity, specificity, level of detectionhttp://www.dovepress.com/diagnostic-accuracy-of-sensitive-or-high-sensitive-troponin-on-present-peer-reviewed-article-VHRM |
| spellingShingle | Sethi A Bajaj A Malhotra G Arora RR Khosla S Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review Vascular Health and Risk Management |
| title | Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review |
| title_full | Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review |
| title_fullStr | Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review |
| title_full_unstemmed | Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review |
| title_short | Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review |
| title_sort | diagnostic accuracy of sensitive or high sensitive troponin on presentation for myocardial infarction a meta analysis and systematic review |
| url | http://www.dovepress.com/diagnostic-accuracy-of-sensitive-or-high-sensitive-troponin-on-present-peer-reviewed-article-VHRM |
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