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Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome

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Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. / Chapman, Andrew R; Lee, Kuan Ken; McAllister, David A; Cullen, Louise; Greenslade, Jaimi H; Parsonage, William; Worster, Andrew; Kavsak, Peter A; Blankenberg, Stefan; Neumann, Johannes; Sörensen, Nils A; Westermann, Dirk; Buijs, Madelon M; Verdel, Gerard J E; Pickering, John W; Than, Martin P; Twerenbold, Raphael; Badertscher, Patrick; Sabti, Zaid; Mueller, Christian; Anand, Atul; Adamson, Philip; Strachan, Fiona E; Ferry, Amy; Sandeman, Dennis; Gray, Alasdair; Body, Richard; Keevil, Brian; Carlton, Edward; Greaves, Kim; Korley, Frederick K; Metkus, Thomas S; Sandoval, Yader; Apple, Fred S; Newby, David E; Shah, Anoop S V; Mills, Nicholas L.

in: JAMA-J AM MED ASSOC, Jahrgang 318, Nr. 19, 21.11.2017, S. 1913-1924.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung

Harvard

Chapman, AR, Lee, KK, McAllister, DA, Cullen, L, Greenslade, JH, Parsonage, W, Worster, A, Kavsak, PA, Blankenberg, S, Neumann, J, Sörensen, NA, Westermann, D, Buijs, MM, Verdel, GJE, Pickering, JW, Than, MP, Twerenbold, R, Badertscher, P, Sabti, Z, Mueller, C, Anand, A, Adamson, P, Strachan, FE, Ferry, A, Sandeman, D, Gray, A, Body, R, Keevil, B, Carlton, E, Greaves, K, Korley, FK, Metkus, TS, Sandoval, Y, Apple, FS, Newby, DE, Shah, ASV & Mills, NL 2017, 'Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome', JAMA-J AM MED ASSOC, Jg. 318, Nr. 19, S. 1913-1924. https://doi.org/10.1001/jama.2017.17488

APA

Chapman, A. R., Lee, K. K., McAllister, D. A., Cullen, L., Greenslade, J. H., Parsonage, W., Worster, A., Kavsak, P. A., Blankenberg, S., Neumann, J., Sörensen, N. A., Westermann, D., Buijs, M. M., Verdel, G. J. E., Pickering, J. W., Than, M. P., Twerenbold, R., Badertscher, P., Sabti, Z., ... Mills, N. L. (2017). Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. JAMA-J AM MED ASSOC, 318(19), 1913-1924. https://doi.org/10.1001/jama.2017.17488

Vancouver

Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W et al. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. JAMA-J AM MED ASSOC. 2017 Nov 21;318(19):1913-1924. https://doi.org/10.1001/jama.2017.17488

Bibtex

@article{506cd45c0b9d4ee989516e08ea06cc4e,
title = "Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome",
abstract = "Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain.Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017.Study Selection: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction.Data Extraction and Synthesis: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model.Main Outcomes and Measures: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data.Results: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death.Conclusions and Relevance: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification.",
keywords = "Acute Coronary Syndrome/blood, Adult, Biomarkers/blood, Death, Humans, Male, Myocardial Infarction/blood, Prognosis, Prospective Studies, Risk Assessment/methods, Troponin I/blood",
author = "Chapman, {Andrew R} and Lee, {Kuan Ken} and McAllister, {David A} and Louise Cullen and Greenslade, {Jaimi H} and William Parsonage and Andrew Worster and Kavsak, {Peter A} and Stefan Blankenberg and Johannes Neumann and S{\"o}rensen, {Nils A} and Dirk Westermann and Buijs, {Madelon M} and Verdel, {Gerard J E} and Pickering, {John W} and Than, {Martin P} and Raphael Twerenbold and Patrick Badertscher and Zaid Sabti and Christian Mueller and Atul Anand and Philip Adamson and Strachan, {Fiona E} and Amy Ferry and Dennis Sandeman and Alasdair Gray and Richard Body and Brian Keevil and Edward Carlton and Kim Greaves and Korley, {Frederick K} and Metkus, {Thomas S} and Yader Sandoval and Apple, {Fred S} and Newby, {David E} and Shah, {Anoop S V} and Mills, {Nicholas L}",
year = "2017",
month = nov,
day = "21",
doi = "10.1001/jama.2017.17488",
language = "English",
volume = "318",
pages = "1913--1924",
journal = "JAMA-J AM MED ASSOC",
issn = "0098-7484",
publisher = "American Medical Association",
number = "19",

}

RIS

TY - JOUR

T1 - Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome

AU - Chapman, Andrew R

AU - Lee, Kuan Ken

AU - McAllister, David A

AU - Cullen, Louise

AU - Greenslade, Jaimi H

AU - Parsonage, William

AU - Worster, Andrew

AU - Kavsak, Peter A

AU - Blankenberg, Stefan

AU - Neumann, Johannes

AU - Sörensen, Nils A

AU - Westermann, Dirk

AU - Buijs, Madelon M

AU - Verdel, Gerard J E

AU - Pickering, John W

AU - Than, Martin P

AU - Twerenbold, Raphael

AU - Badertscher, Patrick

AU - Sabti, Zaid

AU - Mueller, Christian

AU - Anand, Atul

AU - Adamson, Philip

AU - Strachan, Fiona E

AU - Ferry, Amy

AU - Sandeman, Dennis

AU - Gray, Alasdair

AU - Body, Richard

AU - Keevil, Brian

AU - Carlton, Edward

AU - Greaves, Kim

AU - Korley, Frederick K

AU - Metkus, Thomas S

AU - Sandoval, Yader

AU - Apple, Fred S

AU - Newby, David E

AU - Shah, Anoop S V

AU - Mills, Nicholas L

PY - 2017/11/21

Y1 - 2017/11/21

N2 - Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain.Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017.Study Selection: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction.Data Extraction and Synthesis: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model.Main Outcomes and Measures: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data.Results: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death.Conclusions and Relevance: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification.

AB - Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain.Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017.Study Selection: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction.Data Extraction and Synthesis: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model.Main Outcomes and Measures: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data.Results: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death.Conclusions and Relevance: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification.

KW - Acute Coronary Syndrome/blood

KW - Adult

KW - Biomarkers/blood

KW - Death

KW - Humans

KW - Male

KW - Myocardial Infarction/blood

KW - Prognosis

KW - Prospective Studies

KW - Risk Assessment/methods

KW - Troponin I/blood

U2 - 10.1001/jama.2017.17488

DO - 10.1001/jama.2017.17488

M3 - SCORING: Review article

C2 - 29127948

VL - 318

SP - 1913

EP - 1924

JO - JAMA-J AM MED ASSOC

JF - JAMA-J AM MED ASSOC

SN - 0098-7484

IS - 19

ER -