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Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review.

Sethi A, Bajaj A, Malhotra G, Arora RR, Khosla S - Vasc Health Risk Manag (2014)

Bottom Line: Random effect meta-analyses and meta-regression were performed.There was no statistically significant difference in the area under the curve between hsTrop (95% CI: 0.920) and conventional Trop (95% CI: 0.929) at the 99th percentile (P=0.62). hsTrop at the level of detection had a sensitivity of 0.97 (95% CI: 0.96-0.98) and a specificity of 0.41 (95% CI: 0.40-0.42).Five studies were included in the secondary analysis; hsTrop T (Hoffman-La Roche Ltd) had a sensitivity of 0.91 (95% CI: 0.89-0.93) and a specificity of 0.67 (95% CI: 0.63-0.70).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.

ABSTRACT

Background: Recently, high-sensitive troponin (hsTrop) assays consistent with professional societies' recommendations became available. We aimed to summarize the evidence on the diagnostic accuracy of hsTrop on presentation.

Methods: We searched electronic databases for studies evaluating the diagnostic accuracy of hsTrop in suspected acute coronary syndrome (ACS) patients. Random effect meta-analyses and meta-regression were performed. Primary and secondary analyses were restricted to studies using conventional Trop and hsTrop in the reference standard, respectively.

Results: Fifteen studies with a total of 8,628 patients met the inclusion criteria for the primary analysis. hsTrop T (Hoffman-La Roche Ltd) and hsTrop I (Siemens) had sensitivities of 0.89 (95% confidence interval [CI]: 0.86-0.91) and 0.90 (95% CI: 0.87-0.92) and specificities of 0.79 (95% CI: 0.77-0.80) and 0.89 (95% CI: 0.87-0.90), respectively. There was no statistically significant difference in the area under the curve between hsTrop (95% CI: 0.920) and conventional Trop (95% CI: 0.929) at the 99th percentile (P=0.62). hsTrop at the level of detection had a sensitivity of 0.97 (95% CI: 0.96-0.98) and a specificity of 0.41 (95% CI: 0.40-0.42). The studies using a cut-off at coefficient of variance <10% as opposed to the 99th percentile for the conventional assay used for diagnosis reported higher diagnostic accuracy (relative diagnostic odds ratio =2.13, P=0.02). Five studies were included in the secondary analysis; hsTrop T (Hoffman-La Roche Ltd) had a sensitivity of 0.91 (95% CI: 0.89-0.93) and a specificity of 0.67 (95% CI: 0.63-0.70). There was significant heterogeneity among the studies.

Conclusion: hsTrop have excellent diagnostic accuracy for myocardial infarction on presentation, but may not outperform conventional Trop assays. The variation among the studies can be explained, in part, by the cut-off used for conventional Trop assays.

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Related in: MedlinePlus

Summary receiver operating plots: (A) conventional troponin, (B) sensitive/high-sensitive troponin at 99th percentile cut-off, and (C) high-sensitive troponin at the level of detection.Notes: AUC (A) versus (B) (P=0.62), and (A) versus (C) (P=0.2344). Each dot represents study level estimate. The central curve represents the summary estimate of the AUC derived from the study level data, and the upper and lower curve represent its 95% confidence interval.Abbreviations: AUC, area under the curve; SE, standard error; SROC, summary receiver operating curve.
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f3-vhrm-10-435: Summary receiver operating plots: (A) conventional troponin, (B) sensitive/high-sensitive troponin at 99th percentile cut-off, and (C) high-sensitive troponin at the level of detection.Notes: AUC (A) versus (B) (P=0.62), and (A) versus (C) (P=0.2344). Each dot represents study level estimate. The central curve represents the summary estimate of the AUC derived from the study level data, and the upper and lower curve represent its 95% confidence interval.Abbreviations: AUC, area under the curve; SE, standard error; SROC, summary receiver operating curve.

Mentions: Among the included studies, ten studies reported the diagnostic accuracy of conventional trop assays on presentation. The SROC of conventional Trop assays, s/hsTrop assays at a cut-off of 99th percentile, and the LOD is shown in Figure 3. There was no statistically significant difference between the AUC of conventional Trop and s/hsTrop at two different cut-offs.


Diagnostic accuracy of sensitive or high-sensitive troponin on presentation for myocardial infarction: a meta-analysis and systematic review.

Sethi A, Bajaj A, Malhotra G, Arora RR, Khosla S - Vasc Health Risk Manag (2014)

Summary receiver operating plots: (A) conventional troponin, (B) sensitive/high-sensitive troponin at 99th percentile cut-off, and (C) high-sensitive troponin at the level of detection.Notes: AUC (A) versus (B) (P=0.62), and (A) versus (C) (P=0.2344). Each dot represents study level estimate. The central curve represents the summary estimate of the AUC derived from the study level data, and the upper and lower curve represent its 95% confidence interval.Abbreviations: AUC, area under the curve; SE, standard error; SROC, summary receiver operating curve.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4115590&req=5

f3-vhrm-10-435: Summary receiver operating plots: (A) conventional troponin, (B) sensitive/high-sensitive troponin at 99th percentile cut-off, and (C) high-sensitive troponin at the level of detection.Notes: AUC (A) versus (B) (P=0.62), and (A) versus (C) (P=0.2344). Each dot represents study level estimate. The central curve represents the summary estimate of the AUC derived from the study level data, and the upper and lower curve represent its 95% confidence interval.Abbreviations: AUC, area under the curve; SE, standard error; SROC, summary receiver operating curve.
Mentions: Among the included studies, ten studies reported the diagnostic accuracy of conventional trop assays on presentation. The SROC of conventional Trop assays, s/hsTrop assays at a cut-off of 99th percentile, and the LOD is shown in Figure 3. There was no statistically significant difference between the AUC of conventional Trop and s/hsTrop at two different cut-offs.

Bottom Line: Random effect meta-analyses and meta-regression were performed.There was no statistically significant difference in the area under the curve between hsTrop (95% CI: 0.920) and conventional Trop (95% CI: 0.929) at the 99th percentile (P=0.62). hsTrop at the level of detection had a sensitivity of 0.97 (95% CI: 0.96-0.98) and a specificity of 0.41 (95% CI: 0.40-0.42).Five studies were included in the secondary analysis; hsTrop T (Hoffman-La Roche Ltd) had a sensitivity of 0.91 (95% CI: 0.89-0.93) and a specificity of 0.67 (95% CI: 0.63-0.70).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Cardiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.

ABSTRACT

Background: Recently, high-sensitive troponin (hsTrop) assays consistent with professional societies' recommendations became available. We aimed to summarize the evidence on the diagnostic accuracy of hsTrop on presentation.

Methods: We searched electronic databases for studies evaluating the diagnostic accuracy of hsTrop in suspected acute coronary syndrome (ACS) patients. Random effect meta-analyses and meta-regression were performed. Primary and secondary analyses were restricted to studies using conventional Trop and hsTrop in the reference standard, respectively.

Results: Fifteen studies with a total of 8,628 patients met the inclusion criteria for the primary analysis. hsTrop T (Hoffman-La Roche Ltd) and hsTrop I (Siemens) had sensitivities of 0.89 (95% confidence interval [CI]: 0.86-0.91) and 0.90 (95% CI: 0.87-0.92) and specificities of 0.79 (95% CI: 0.77-0.80) and 0.89 (95% CI: 0.87-0.90), respectively. There was no statistically significant difference in the area under the curve between hsTrop (95% CI: 0.920) and conventional Trop (95% CI: 0.929) at the 99th percentile (P=0.62). hsTrop at the level of detection had a sensitivity of 0.97 (95% CI: 0.96-0.98) and a specificity of 0.41 (95% CI: 0.40-0.42). The studies using a cut-off at coefficient of variance <10% as opposed to the 99th percentile for the conventional assay used for diagnosis reported higher diagnostic accuracy (relative diagnostic odds ratio =2.13, P=0.02). Five studies were included in the secondary analysis; hsTrop T (Hoffman-La Roche Ltd) had a sensitivity of 0.91 (95% CI: 0.89-0.93) and a specificity of 0.67 (95% CI: 0.63-0.70). There was significant heterogeneity among the studies.

Conclusion: hsTrop have excellent diagnostic accuracy for myocardial infarction on presentation, but may not outperform conventional Trop assays. The variation among the studies can be explained, in part, by the cut-off used for conventional Trop assays.

Show MeSH
Related in: MedlinePlus