title: Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
authors.forename: Ankur
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Department of Medicine, Wright Center of Graduate Medical Education, Scranton, PA, USA.
authors.forename: Anurag
authors.initials: A
authors.lastname: Bajaj
authors.affiliation: Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
authors.forename: Gurveen
authors.initials: G
authors.lastname: Malhotra
authors.affiliation: Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
authors.forename: Rohit R
authors.initials: RR
authors.lastname: Arora
authors.affiliation: Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: high-sensitive troponin I; high-sensitive troponin T; level of detection; sensitivity; specificity
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