title: Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis.
abstract: BACKGROUND
  Multiple studies have evaluated the diagnostic and prognostic performance of conventional troponin (cTn) and high-sensitivity troponin (hs-cTn). We performed a collaborative meta-analysis comparing cTn and hs-cTn for diagnosis of acute myocardial infarction (AMI) and assessment of prognosis in patients with chest pain.
  
  
  METHODS
  MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing both cTn and hs-cTn in patients with chest pain. Study authors were contacted and many provided previously unpublished data.
  
  
  RESULTS
  From 17 included studies, there were 8,644 patients. Compared with baseline cTn, baseline hs-cTn had significantly greater sensitivity (0.884 vs 0.749, P < .001) and negative predictive value (NPV; 0.964 vs 0.935, P < .001), whereas specificity (0.816 vs 0.938, P < .001) and positive predictive value (0.558 vs 0.759, P < .001) were significantly reduced. Based on summary receiver operating characteristic curves, test performance for the diagnosis of AMI was not significantly different between baseline cTn and hs-cTn (0.90 [95% CI 0.85-0.95] vs 0.92 [95% CI 0.90-0.94]). In a subanalysis of 6 studies that alternatively defined AMI based on hs-cTn, cTn had lower sensitivity (0.666, P < .001) and NPV (0.906, P < .001). Elevation of baseline hs-cTn, but negative baseline cTn, was associated with increased risk of death or nonfatal myocardial infarction during follow-up (P < .001) compared with both negative.
  
  
  CONCLUSIONS
  High-sensitivity troponin has significantly greater early sensitivity and NPV for the diagnosis of AMI at the cost of specificity and positive predictive value, which may enable early rule in/out of AMI in patients with chest pain. Baseline hs-cTn elevation in the setting of negative cTn is also associated with increased nonfatal myocardial infarction or death during follow-up.
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escárcega
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Aldous
authors.affiliation: Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.affiliation: Clinical Blood Sciences Laboratory, St George's Hospital, London, United Kingdom.
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Goodacre
authors.affiliation: Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mair
authors.affiliation: Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Frankenhausen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lotze
authors.affiliation: Départment des urgences, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
authors.affiliation: Département de Biochimie, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
authors.affiliation: Department of Emergency Medicine and Surgery, Hôspital Pitié-Salpétrière, APHP, Université Pierre et Marie Curie-Paris 6 (UPMC), Paris, France.
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Freund
authors.affiliation: Clinical Chemistry Laboratory, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.affiliation: Cardiology Department, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Paris, France; Cardiology Department, Paris XIII University, Avicenne Hospital, Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.affiliation: Department of Coronary and Structural Heart Diseases, National Insititute of Cardiology, Warsaw, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Pracoń
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Schreiber
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, CA.
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Servei de Bioquímica Clínica, Hospital de Sant Pau, Barcelona, Spain; Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordoñez-Llanos
authors.affiliation: Division of Cardiology, Mayo Clinic College of Medicine, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland; Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart Institute, Medstar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D002637:Chest Pain / Q000097:blood* / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin