Comparison of conventional and high-sensitivity troponin in patients with chest pain: A collaborative meta-analysis

Lipinski, Michael J.; Baker, Nevin C.; Escárcega, Ricardo O.; Torguson, Rebecca; Chen, Fang; Aldous, Sally; Christ, Michael; Collinson, Paul; Goodacre, Steve; Mair, Johannes; Inoue, Kenji; Lotze, Ulrich; Sebbane, Mustapha; Cristol, Jean‐Paul; Freund, Yonathan; Chenevier‐Gobeaux, Camille; Meune, Christophe; Eggers, Kai M.; Pracoń, Radosław; Schreiber, Donald; Wu, Alan H.B.; Ordóñez-Llanos, Jordi; Jaffe, Allan S.; Twerenbold, Raphael; Müeller, Christian; Waksman, Ron

doi:10.1016/j.ahj.2014.10.007

Cited by 91 publications

(80 citation statements)

References 33 publications

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“…Additionally, since the hs‐TnT assay was approved for use in the United States in 2017, we could not use these assays in our patients. Though the hs‐TnT assay has demonstrated greater sensitivity and negative predictive value in AMI, there are limited data comparing these 2 assays in the septic population 37. The development of the sepsis‐3 criteria could influence the interpretation of the results of this study 38.…”

Section: Discussionmentioning

confidence: 96%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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BackgroundTroponin‐T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin‐T testing in the prognostication of these patients.Methods and ResultsThis was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin‐T and significant delta troponin‐T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in‐hospital mortality. Secondary outcomes included 1‐year mortality and lengths of stay. During this 8‐year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin‐T ≥0.01 ng/mL. Serial troponin‐T values were available in 732 (78%) patients. Elevated admission troponin‐T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin‐T was associated with higher severity of illness. Admission log10 troponin‐T was associated with unadjusted in‐hospital (odds ratio 1.6; P=0.003) and 1‐year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin‐T and log10 delta troponin‐T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin‐T remained an independent predictor of in‐hospital mortality (odds ratio 1.4; P=0.04) and 1‐year survival (hazard ratio 1.3; P=0.008).ConclusionsIn patients with sepsis and septic shock, elevated admission troponin‐T was associated with higher short‐ and long‐term mortality. Routine serial troponin‐T testing did not add incremental prognostic value in these patients.

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Section: Discussionmentioning

confidence: 96%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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“…High-sensitivity troponins allow earlier detection and have shown superiority in ACS diagnosis compared to conventional troponins [21,22]. As a consequence, high-sensitivity troponins are now used as the reference for patients presenting with chest pain and/or suspected ACS [21,22]. However, copeptin, by its independent pathophysiology and its rapid release after ACS, could further improve diagnostic accuracy in this setting.…”

Section: Copeptin In Acsmentioning

confidence: 96%

“…Owing to the high proportion of patients who present in ED with suspected ACS, new troponin assays have been developed to overcome this major limitation. High-sensitivity troponins allow earlier detection and have shown superiority in ACS diagnosis compared to conventional troponins [21,22]. As a consequence, high-sensitivity troponins are now used as the reference for patients presenting with chest pain and/or suspected ACS [21,22].…”

Section: Copeptin In Acsmentioning

confidence: 98%

Copeptin in acute coronary syndromes and heart failure management: State of the art and future directions

Schurtz

Lamblin

Bauters

et al. 2015

Archives of Cardiovascular Diseases

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Over the past two decades, the use of multiple biomarkers has changed cardiovascular disease management. Recently, several trials have assessed the diagnostic and prognostic performances of copeptin, especially in patients with heart failure or acute coronary syndromes. Primary results are interesting, with copeptin looking promising for: the management of patients who present at emergency departments early after chest pain onset and the risk stratification of patients with heart failure. The purpose of this article is to review the data on the place of copeptin in the management of patients with chest pain or heart failure.

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“…Finally, comparison of conventional and high-sensitivity assays shows that high-sensitivity assays detect prognostically significant disease missed by conventional sensitive assays. 5 The third theme is the use of additional biomarkers to allow early discharge from the emergency department. The concept is to measure hs cTn plus the extra marker on admission.…”

Section: Introductionmentioning

confidence: 99%

Detecting cardiac events – state-of-the-art

Collinson

2015

Ann Clin Biochem

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Cardiac biomarker measurement currently addresses two key questions in patient management: the differential diagnosis of chest pain and the differential diagnosis of the patient with breathlessness. There are currently three major themes in the strategies for the differential diagnosis of chest pain. The first is to undertake troponin measurement in patients selected to be at lower risk, hence to have a low prior probability of disease. The second is the introduction of high-sensitivity cardiac troponin (hs cTn) assays into routine clinical use with measurement at 0 and 3 h from admission. Two other approaches that utilize the diagnostic characteristics of these assays have also been suggested. The first is to use the limit of detection or limit of blank of the assay as the diagnostic discriminant. The second approach is to use the low imprecision of the assay within the reference interval and combine a discriminant value with an absolute rate of change (delta value). The third is the use of additional biomarkers to allow early discharge from the emergency department. The concept is to measure high-sensitivity cardiac troponin plus the extra marker on admission. The role of measurement of B-type natriuretic peptide or its N-terminal prohormone, N-terminal pro-B-type natriuretic peptide, has been accepted and incorporated into guidelines for chronic heart failure for some time. More recently, guidelines for acute heart failure can also recommend a single measurement of B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide in people presenting with new suspected acute heart failure.

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Comparison of conventional and high-sensitivity troponin in patients with chest pain: A collaborative meta-analysis

Cited by 91 publications

References 33 publications

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Copeptin in acute coronary syndromes and heart failure management: State of the art and future directions

Detecting cardiac events – state-of-the-art

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