title: Use of high-sensitivity troponin assays predicts mortality in patients with normal conventional troponin assays on admission-insights from a meta-analysis.
abstract: BACKGROUND
  Use of high-sensitivity troponin (hs-Tn) assays can detect small levels of myocardial damage previously undetectable with conventional troponin (c-Tn) assays. However, prognostic utility of these hs-Tn assays in prediction of mortality remains unclear in the presence of nonelevated c-Tn levels on admission. A systematic review and meta-analysis was performed to assess mortality risk of patients with hs-Tn elevations in the setting of normal c-Tn levels.
  
  
  OBJECTIVE
  Patients with hs-Tn elevations with normal c-Tn levels on admission blood samples, drawn to rule out acute coronary syndrome (ACS), have a higher mortality risk than those without hs-Tn or c-Tn elevations.
  
  
  METHODS
  A search was made of the PubMed, CENTRAL, EMBASE, CINAHL, EBSCO, and Web of Science databases. Studies evaluating patients with suspected ACS that reported mortality rates for those with elevated hs-Tn levels but normal c-Tn levels on admission were included. A random-effects model was used to pool event rates, and data were reported in odds ratios (95% confidence interval).
  
  
  RESULTS
  Four studies (N = 2033, mean age 64-75 years, 49%-70% male) revealed that nearly 32% of suspected ACS patients with normal c-Tn levels on admission had elevated hs-Tn levels. Elevated hs-Tn levels conferred a significantly higher risk of all-cause mortality vs normal hs-Tn levels (odds ratio: 4.35, 95% confidence interval: 2.81-6.73, P < 0.01), with negligible heterogeneity (I(2) = 0%).
  
  
  CONCLUSIONS
  Elevation of hs-Tn levels predicted a higher risk of mortality in patients with suspected ACS and may aid in the early identification of higher-risk patients in this setting. Future studies are needed to investigate further optimal management strategies.
authors.affiliation: Division of Cardiology, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Brown University, Providence, Rhode Island.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.forename: Ali
authors.initials: A
authors.lastname: Dahhan
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
authors.forename: Satish
authors.initials: S
authors.lastname: Sharma
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D014336:Troponin / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D014336:Troponin
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