MedStar Authors catalog › Details for: Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis.
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Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis.

by Lipinski, Michael J; Baker, Nevin C; Escarcega, Ricardo O; Torguson, Rebecca; Chen, Fang; Waksman, Ron.
Citation: American Heart Journal. 169(1):6-16.e6, 2015 Jan..Journal: American heart journal.ISSN: 0002-8703.Full author list: Lipinski MJ; Baker NC; Escarcega RO; Torguson R; Chen F; Aldous SJ; Christ M; Collinson PO; Goodacre SW; Mair J; Inoue K; Lotze U; Sebbane M; Cristol JP; Freund Y; Chenevier-Gobeaux C; Meune C; Eggers KM; Pracon R; Schreiber DH; Wu AH; Ordonez-Llanos J; Jaffe AS; Twerenbold R; Mueller C; Waksman R.UI/PMID: 25497242.Subject(s): *Chest Pain/bl [Blood] | Chest Pain/et [Etiology] | Humans | *Myocardial Infarction/di [Diagnosis] | Myocardial Infarction/mo [Mortality] | Prognosis | ROC Curve | Sensitivity and Specificity | *Troponin/bl [Blood]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Meta-AnalysisOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: Am Heart J. 169(1):6-16.e6, 2015 Jan.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.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.Abstract: 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 Study authors were contacted and many provided previously unpublished data.Abstract: RESULTS: From 17 included studies, there were 8,644 patients.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.Abstract: CONCLUSION: 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.Copyright � 2014 Elsevier Inc. All rights reserved.

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