Early diagnostic and prognostic utility of high-sensitive troponin assays in acute myocardial infarction: a meta-analysis.
OBJECTIVE
To determine the diagnostic and prognostic utility of high-sensitive troponin assays in the very early phase of acute myocardial infarction (AMI) (less than 3 h since symptoms onset) by performing a meta-analysis of prospective studies.


METHODS
Relevant studies were identified by searches of MEDLINE and Elsevier Sciencedirect until 31 January 2014 and by reviewing the reference lists from retrieved articles. Prospective studies that reported diagnostic utility in AMI using both high-sensitive troponin assays and conventional cardiac troponin, and reported the estimates of hazard ratio (HR) with 95% confidence intervals (CI) for prognostic utility were included. Data were extracted independently by two authors and summary estimates of association were obtained using a random effects model.


RESULTS
Of the seven studies included, four studies reported the diagnostic utility of high-sensitive troponin assays (2863 patients) and three reported the prognostic utility in AMI (2329 patients). Within 12 h of symptoms onset, the pooled sensitivity and specificity of high-sensitive troponin assays were 0.89 (95% CI 0.85-0.91) and 0.89 (95% CI 0.85-0.92), respectively, and within 3 h, the pooled sensitivity and specificity of high-sensitive troponin assays were 0.79 (95% CI 0.71-0.85) and 0.92 (95% CI 0.88-0.96) respectively. Compared with conventional cardiac troponin assays, the high-sensitive troponin assays had higher sensitivity (0.89 vs 0.72) but lower specificity (0.89 vs 0.95) in diagnosing AMI within 12 h of symptoms onset. Within 3 h, the sensitivity of high-sensitive troponin assays was still higher (0.79 vs 0.59), but the specificity was almost the same (0.92 vs 0.95) as that of conventional troponin assays. The elevated high-sensitive troponin assays had an overall pooled HR of 2.66 (95% CI 1.31-5.44) and 2.14 (95% CI 1.15-3.98) for the end-points of death and non-fatal AMI respectively.


CONCLUSIONS
These findings provide quantitative data supporting high-sensitive troponin assays having early diagnostic and prognostic utility in AMI.
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.|Department of Cardiology, Guangzhou First Municipal People's Hospital, Guangzhou, China.
W-J
WJ
Li
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
X-M
XM
Chen
Outpatient Department, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
X-Y
XY
Nie
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
X-X
XX
Lin
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Y-J
YJ
Cheng
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
C-H
CH
Hu
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Z-M
ZM
Du
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Y-G
YG
Dong
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
H
H
Ma
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
S-H
SH
Wu
D015415:Biomarkers / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*
D015415:Biomarkers; D014336:Troponin
diagnostic utility; high-sensitive troponin assay; meta-analysis; prognostic utility