High-Sensitivity Cardiac Troponin I Threshold Identifies Patients at Low Risk for MI, Death

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The researchers found that 49% of patients had cardiac troponin I concentrations <5 ng/L at presentation.
The researchers found that 49% of patients had cardiac troponin I concentrations <5 ng/L at presentation.

HealthDay News — High-sensitivity cardiac troponin I concentration can identify individuals at low risk of myocardial infarction or cardiac death within 30 days among patients with suspected acute coronary syndrome, according to a review published in the Journal of the American Medical Association to coincide with the American Heart Association's Scientific Sessions, held from November 11 to 15 in Anaheim, California.

Andrew R. Chapman, MD, from the University of Edinburgh in Scotland, and colleagues conducted a systematic review to examine the performance of a cardiac troponin I threshold of 5 ng/L at presentation for risk stratification in patients with suspected acute coronary syndrome.

The primary outcome of myocardial infarction or cardiac death at 30 days occurred in 12.4% of the 22,457 patients included in the meta-analysis. The researchers found that 49% of patients had cardiac troponin I concentrations <5 ng/L at presentation; among these patients there were 60 missed index or 30-day events, resulting in a negative predictive value of 99.5 percent for the primary outcome. There were no and 7 (0.1%) cardiac deaths at 30 days and one year, respectively, with a negative predictive value of 99.9% for cardiac death.

"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," the authors write.

Several authors disclosed financial ties to the biopharmaceutical and medical device industries.

Reference

Chapman AR, Lee KK, McAllister DA, et al. Association of high-sensitivity cardiac troponin I concentration with cardiac outcomes in patients with suspected acute coronary syndrome [published online November 11, 2017]. JAMA. doi:10.1001/jama.2017.17488

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