Diagnostic and prognostic utility of troponin estimation in patients presenting with syncope: a prospective cohort study

Reed, Matthew J; Newby, David E.; Coull, Andrew; Prescott, R. J.; Gray, Alasdair

doi:10.1136/emj.2008.068635

Cited by 18 publications

(18 citation statements)

References 21 publications

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“…31 Similar findings were not reported in the two remaining studies that looked at the outcome measure of other serious AEs. 31 Similar findings were not reported in the two remaining studies that looked at the outcome measure of other serious AEs.…”

Section: Other Serious Aessupporting

confidence: 70%

“…Significant statistical heterogeneity among studies was observed (χ 2 = 2250.74; P < 0.001), with 99.7% of variation in estimated size attributable to differences in study characteristics (I 2 = 99.7). Reed et al 31 noted the mean age was higher in those who had troponin measured (74 AE 14 vs 68 AE 18 years, P = 0.018).…”

Section: Proportion Of Troponins Measuredmentioning

confidence: 96%

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Review article: Utility of troponin after syncope: A systematic review and meta‐analysis

Stark

Smit

Mitra

2018

Emerg Medicine Australasia

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The role of serum troponin testing in patients presenting to the ED after syncope is unclear. The aim of this systematic review was to examine the practice and utility of troponin testing among patients presenting to the ED after syncope. We conducted a search of MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases from 1990 to February 2017 using keyword and subject headings for syncope and troponin testing. Design and results of the included studies are extracted. Studies were assessed for heterogeneity and the pooled proportion of measured troponin and positive troponin result described. There were nine studies included for analysis. Significant statistical heterogeneity among studies was observed (P < 0.001). Using the random effects model, the pooled proportion of patients presenting to the ED after syncope who had troponin measured was 0.64 (95% CI 0.46-0.82). Among patients who had been troponin tested, the pooled proportion who had a positive result was 0.19 (95% CI 0.13-0.26). Variability among reported outcomes prevented further meta-analysis. Troponin testing was commonly performed for the assessment of patients with syncope with a substantial proportion returning positive results. The correlation between raised troponin and patient outcomes was not adequately reported. It is possible that an elevated troponin may indicate serious illness, rather than myocardial damage alone.

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Section: Other Serious Aessupporting

confidence: 70%

Section: Proportion Of Troponins Measuredmentioning

confidence: 96%

Review article: Utility of troponin after syncope: A systematic review and meta‐analysis

Stark

Smit

Mitra

2018

Emerg Medicine Australasia

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“…Almost 20% of patients had troponin concentrations above our institution's current diagnostic threshold of 0.05 ng/ml for myocardial infarction. Yet only 2% of patients were diagnosed with myocardial infarction in our original study where a higher diagnostic threshold of 0.20 ng/ml was in use 1. We found that in patients with syncope, any increase in troponin concentration was associated with increasing risk of serious outcome and death at both 1 month and 1 year, even at very low levels of troponin.…”

Section: Discussionmentioning

confidence: 64%

“…Our group has already reported that plasma troponin concentration may predict 1-month serious outcome or all-cause death in syncope1 in a cohort of 289 patients enrolled into the ROSE study 2. These patients were admitted during the validation of a contemporary sensitive troponin I assay in our institution 3.…”

Section: Introductionmentioning

confidence: 99%

Sensitive troponin assay predicts outcome in syncope

2012

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“…Troponin is not required to rule out acute coronary syndrome (ACS) or myocardial infarction (MI) unless the ECG shows changes consistent with acute ischaemia 45. While high sensitivity troponin does have prognostic ability (ie, it can predict short-term (1 month) and long-term (1 year) risk of serious outcome and death),46 47 it is not practice changing in clinical practice as yet and should presently only be measured if ACS or MI is suspected.…”

Section: When Is a Troponin To Rule Out Acute Coronary Syndrome Requimentioning

confidence: 99%

Approach to syncope in the emergency department

Reed

2018

Emerg Med J

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Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge.

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Diagnostic and prognostic utility of troponin estimation in patients presenting with syncope: a prospective cohort study

Cited by 18 publications

References 21 publications

Review article: Utility of troponin after syncope: A systematic review and meta‐analysis

Review article: Utility of troponin after syncope: A systematic review and meta‐analysis

Sensitive troponin assay predicts outcome in syncope

Approach to syncope in the emergency department

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