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High-sensitivity troponin (hsTrop) assays can detect smaller myocardial infarctions (MI) undetectable with contemporary troponin assays (cTrop), it is unclear whether patients with hsTrop elevations in setting of normal cTrop have higher mortality.
A search was made of PubMed, CENTRAL, EMBASE, CINAHL, EBSCO, and Web of Science databases for studies that reported mortality rates for patients with elevated hsTrops in comparison to non-elevated cTrop. All studies had detection threshold of >99 % upper reference limit of normal, and <20% coefficient of variation at detection limit. Both random effect and fixed effect models were used to pool event rates (OR; 95% confidence interval [CI]).
Analysis of five studies (N=2451, age 54-75 years, follow-up 1-24 months) revealed elevated hsTrop in patients with negative cTrop confers a significantly higher risk of all cause mortality-(OR 3.49, 95% CI 2.22–5.47; p<0.01); without evidence of significant heterogeneity (I2=19%).15 (95% CI 11–23) people with negative cTrop when tested with hsTrop will identify 1 person at elevated risk of mortality.
Elevation of hsTrop on admission, in patients with negative cTrop assays significantly predict higher risk of mortality. The use of high sensitivity troponin assays can aid in identification of high-risk patients at earlier time points. Caution should be exercised in management of these patients with future studies directed towards optimal management and follow up.
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-200
- 2013 American College of Cardiology Foundation