Clinical study: acute coronary symdrome
The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis

https://doi.org/10.1016/S0735-1097(01)01388-2Get rights and content
Under an Elsevier user license
open archive

Abstract

OBJECTIVES

This study was designed to compare the prognostic value of an abnormal troponin level derived from studies of patients with non-ST elevation acute coronary syndromes (ACS).

BACKGROUND

Risk stratification for patients with suspected ACS is important for determining need for hospitalization and intensity of treatment.

METHODS

We identified clinical trials and cohort studies of consecutive patients with suspected ACS without ST-elevation from 1966 through 1999. We excluded studies limited to patients with acute myocardial infarction and studies not reporting mortality or troponin results.

RESULTS

Seven clinical trials and 19 cohort studies reported data for 5,360 patients with a troponin T test and 6,603 with a troponin I test. Patients with positive troponin (I or T) had significantly higher mortality than those with a negative test (5.2% vs. 1.6%, odds ratio [OR] 3.1). Cohort studies demonstrated a greater difference in mortality between patients with a positive versus negative troponin I (8.4% vs. 0.7%, OR 8.5) than clinical trials (4.8% if positive, 2.1% if negative, OR 2.6, p = 0.01). Prognostic value of a positive troponin T was also slightly greater for cohort studies (11.6% mortality if positive, 1.7% if negative, OR 5.1) than for clinical trials (3.8% if positive, 1.3% if negative, OR 3.0, p = 0.2)

CONCLUSIONS

In patients with non-ST elevation ACS, the short-term odds of death are increased three- to eightfold for patients with an abnormal troponin test. Data from clinical trials suggest a lower prognostic value for troponin than do data from cohort studies.

Abbreviations

ACS
acute coronary syndromes
CI
confidence interval
ECG
electrocardiogram
MI
myocardial infarction
OR
odds ratio
TIMI
Thrombolysis In Myocardial Infarction

Cited by (0)

This study was funded by the Agency for Healthcare Research and Quality, Rockville, Maryland, contract #290-97-0013 to UCSF-Stanford Evidence-Based Practice Center. Dr. Heidenreich is supported by a Career Development Award from the Veterans Affairs Health Services Research and Development Service.