title: Performance of the high-sensitivity troponin assay in diagnosing acute myocardial infarction: systematic review and meta-analysis.
abstract: BACKGROUND
  High-sensitivity cardiac troponin assays have been adopted by many clinical centres worldwide; however, clinicians are uncertain how to interpret the results. We sought to assess the utility of these assays in diagnosing acute myocardial infarction (MI).
  
  
  METHODS
  We carried out a systematic review and meta-analysis of studies comparing high-sensitivity with conventional assays of cardiac troponin levels among adults with suspected acute MI in the emergency department. We searched MEDLINE, EMBASE and Cochrane databases up to April 2013 and used bivariable random-effects modelling to obtain summary parameters for diagnostic accuracy.
  
  
  RESULTS
  We identified 9 studies that assessed the use of high-sensitivity troponin T assays (n = 9186 patients). The summary sensitivity of these tests in diagnosing acute MI at presentation to the emergency department was estimated to be 0.94 (95% confidence interval [CI] 0.89-0.97); for conventional tests, it was 0.72 (95% CI 0.63-0.79). The summary specificity was 0.73 (95% CI 0.64-0.81) for the high-sensitivity assay compared with 0.95 (95% CI 0.93-0.97) for the conventional assay. The differences in estimates of the summary sensitivity and specificity between the high-sensitivity and conventional assays were statistically significant (p < 0.01). The area under the curve was similar for both tests carried out 3-6 hours after presentation. Three studies assessed the use of high-sensitivity troponin I assays and showed similar results.
  
  
  CONCLUSIONS
  Used at presentation to the emergency department, the high-sensitivity cardiac troponin assay has improved sensitivity, but reduced specificity, compared with the conventional troponin assay. With repeated measurements over 6 hours, the area under the curve is similar for both tests, indicating that the major advantage of the high-sensitivity test is early diagnosis.
authors.affiliation: Department of Cardiology, Hamilton Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Ayman
authors.initials: A
authors.lastname: Al-Saleh
authors.affiliation: Department of Cardiology, Hamilton Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Alazzoni
authors.affiliation: Department of Internal Medicine, McMaster University, Hamilton, Ont.
authors.forename: Saleh
authors.initials: S
authors.lastname: Al Shalash
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. ; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ont.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Ye
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. ; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ont. ; Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. ; Departments of Anesthesia and Pediatrics, McMaster University, Hamilton, Ont. ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ont.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Department of Cardiology, Hamilton Health Sciences, McMaster University, Hamilton, Ont. ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ont.
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly