Author + information
Recently, high sensitive troponin (HsTrop) assays consistent with professional societies’ recommendations, with a level of detection and 10% coefficient of variation (CV) below 99 percentile of the normal population became available. We aimed to summarize the available evidence on diagnostic accuracy of these assays.
We systematically searched “Pubmed” database for studies evaluating diagnostic accuracy of HsTrop assay in unselected population suspected of acute coronary syndrome. Relevant study characteristics were extracted and a meta-analysis was performed using a random effect model. A meta- regression of cut off of conventional assay and inclusion of end stage renal disease patients were also performed.
Fifteen studies met the inclusion criterion −8 studies used HsTrop T, 6 studies used HsTrop I and 1 study used both. The HsTrop T had pooled sensitivity of 0.89 (0.86–0.90) and specificity of 0.79 (0.77–0.80). The HsTrop I had pooled sensitivity of 0.87 (0.85–0.89) and specificity of 0.88 (0.87–0.89). The use of novel cut off of any detectable troponin improved pooled sensitivity to 0.98 (0.97–0.99) at a cost of reduced specificity to 0.36 (0.35–0.38). The studies using cut off value above 10% CV for the conventional assay to diagnose Ml reported higher diagnostic accuracy as opposed to 99 percentile for the population (RDOR = 2.13 p =0.02). Inclusion of the patient with chronic kidney disease or dialysis did not have any effect on diagnostic accuracy (DOR = 1.46 p =0.32).
The detectable admission troponin as measured by novel HsTrop assays has a high sensitivity but is not specific for myocardial infarction (Ml). The variation among the studies evaluating diagnostic accuracy of HsTrop can be explained, in part, by variable cut off of conventional troponin assays used to diagnose Ml.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: High Sensitivity Troponins: New Insights
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1302M-196
- 2013 American College of Cardiology Foundation