Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome
| Autor: | Patrick Badertscher, Fiona E. Strachan, David E. Newby, Johannes T Neumann, Fred S. Apple, Christian Mueller, Kim Greaves, Edward Carlton, Louise Cullen, Stefan Blankenberg, John W. Pickering, Thomas S. Metkus, Andrew R. Chapman, Frederick K. Korley, Nicholas L. Mills, Raphael Twerenbold, Kuan Ken Lee, Amy V. Ferry, Nils A. Söerensen, Brian G. Keevil, Martin Than, Dirk Westermann, Philip D Adamson, Gerard J. E. Verdel, Yader Sandoval, Richard Body, Atul Anand, Alasdair Gray, Andrew Worster, Anoop S V Shah, Zaid Sabti, William A. Parsonage, Peter A. Kavsak, Madelon M. Buijs, Jaimi H. Greenslade, David A. McAllister, Dennis Sandeman |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Acute coronary syndrome Myocardial Infarction Review 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Internal medicine Troponin I medicine Journal Article Humans 030212 general & internal medicine Myocardial infarction Prospective Studies Acute Coronary Syndrome Prospective cohort study biology business.industry General Medicine medicine.disease Prognosis Troponin Death Meta-analysis biology.protein Cardiology Myocardial infarction diagnosis Risk assessment business Biomarkers Meta-Analysis |
| Zdroj: | Chapman, A R, Lee, K K, McAllister, D A, Cullen, L, Greenslade, J H, Parsonage, W, Worster, A, Kavsak, P A, Blankenberg, S, Neumann, J, Söerensen, N A, Westermann, D, Buijs, M M, Verdel, G J E, Pickering, J W, Than, M P, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, F E, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, F K, Metkus, T S, Sandoval, Y, Apple, F S, Newby, D E, Shah, A S V & Mills, N L 2017, ' Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome ', Journal of the American Medical Association (JAMA), vol. 318, no. 19, pp. 1913-1924 . https://doi.org/10.1001/jama.2017.17488 Chapman, A R, Lee, K K, McAllister, D A, Cullen, L, Greenslade, J H, Parsonage, W, Worster, A, Kavsak, P A, Blankenberg, S, Neumann, J, Söerensen, N A, Westermann, D, Buijs, M M, Verdel, G J E, Pickering, J W, Than, M P, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, F E, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, F K, Metkus, T S, Sandoval, Y, Apple, F S, Newby, D E, Shah, A S V & Mills, N L 2018, ' Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome ', JAMA, vol. 318, no. 19, pp. 1913-1924 . https://doi.org/10.1001/jama.2017.17488 |
| DOI: | 10.1001/jama.2017.17488 |
| Popis: | Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain.Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017.Study Selection: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction.Data Extraction and Synthesis: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model.Main Outcomes and Measures: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data.Results: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death.Conclusions and Relevance: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|