期刊
AMERICAN HEART JOURNAL
卷 169, 期 1, 页码 6-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.ahj.2014.10.007
关键词
-
资金
- Roche Diagnostics
- St Jude Medical and Medtronic
- Brahms Thermofisher
- Abbott Diagnostics
- Abbott Laboratories
- Singulex, Inc
- Roche Laboratories
- Alere
- Beckman Coulter
- European Union
- Swiss National Science Foundation
- Swiss Heart Foundation
- Basel University
- University Hospital Basel
- Cardiovascular Research Foundation Basel
- Stanley Thomas Johnson Foundation
- Abbott
- Brahms
- Buhlmann
- Critical Diagnostics
- Nanosphere
- Pronota
- Roche
- Siemens
- 8sense
- National Institute for Health Research [06/302/19] Funding Source: researchfish
Background Multiple studies have evaluated the diagnostic and prognostic performance of conventional troponin (cTn) and high-sensitivity troponin (hs-cTn). We performed a collaborative meta-analysis comparing cTn and hs-cTn for diagnosis of acute myocardial infarction (AMI) and assessment of prognosis in patients with chest pain. Methods MEDLINE/PubMed, Cochrane CENTRAL, and EMBASE were searched for studies assessing both cTn and hs-cTn in patients with chest pain. Study authors were contacted and many provided previously unpublished data. Results From 17 included studies, there were 8,644 patients. Compared with baseline cTn, baseline hs-cTn had significantly greater sensitivity (0.884 vs 0.749, P < .001) and negative predictive value (NPV; 0.964 vs 0.935, P < .001), whereas specificity (0.816 vs 0.938, P < .001) and positive predictive value (0.558 vs 0.759, P < .001) were significantly reduced. Based on summary receiver operating characteristic curves, test performance for the diagnosis of AMI was not significantly different between baseline cTn and hs-cTn (0.90 [95% CI 0.85-0.95] vs 0.92 [95% CI 0.90-0.94]). In a subanalysis of 6 studies that alternatively defined AMI based on hs-cTn, cTn had lower sensitivity (0.666, P < .001) and NPV (0.906, P < .001). Elevation of baseline hs-cTn, but negative baseline cTn, was associated with increased risk of death or nonfatal myocardial infarction during follow-up (P < .001) compared with both negative. Conclusion High-sensitivity troponin has significantly greater early sensitivity and NPV for the diagnosis of AMI at the cost of specificity and positive predictive value, which may enable early rule in/out of AMI in patients with chest pain. Baseline hs-cTn elevation in the setting of negative cTn is also associated with increased nonfatal myocardial infarction or death during follow-up.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据