CLINICAL STUDY: ACUTE CORONARY SYMDROME
The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis
Paul A. Heidenreich, MD, MS, FACC*   ,
Thomas Alloggiamento, MD* ,
Kathryn Melsop, MS,
Kathryn M. McDonald, MM ,
Alan S. Go, MD  and
Mark A. Hlatky, MD, FACC
* Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
Departments of Health Research and Policy and Medicine, Stanford University, Stanford, California, USA
Division of Research, Kaiser Permanente Medical Care Program (Northern California), Oakland, California, USA
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
Manuscript received December 1, 2000;
revised manuscript received March 19, 2001,
accepted April 12, 2001.
Reprint requests and correspondence: Dr. Paul Heidenreich, VA Palo Alto, 111C Cardiology, 3801 Miranda Avenue, Palo Alto, California 94304
heiden{at}stanford.edu
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.
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Abbreviations and Acronyms
| | ACS | = acute coronary syndromes | | CI | = confidence interval | | ECG | = electrocardiogram | | MI | = myocardial infarction | | OR | = odds ratio | | TIMI | = Thrombolysis In Myocardial Infarction |
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Ability of Minor Elevations of Troponins I and T to Predict Benefit From an Early Invasive Strategy in Patients With Unstable Angina and Non-ST Elevation Myocardial Infarction: Results From a Randomized Trial
JAMA,
November 21, 2001;
286(19):
2405 - 2412.
[Abstract]
[Full Text]
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M. J. Quinn and D. J. Moliterno
Troponins in Acute Coronary Syndromes: More TACTICS for an Early Invasive Strategy
JAMA,
November 21, 2001;
286(19):
2461 - 2462.
[Full Text]
[PDF]
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Prognostic Value of Troponin in Non-ST-Elevation Acute Coronary Syndromes
Journal Watch Emergency Medicine,
November 14, 2001;
2001(1114):
3 - 3.
[Full Text]
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L. E. Rabbani
Acute Coronary Syndromes -- Beyond Myocyte Necrosis
N. Engl. J. Med.,
October 4, 2001;
345(14):
1057 - 1059.
[Full Text]
[PDF]
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