Acute coronary syndrome: elevated troponin T or I increases the risk of death or myocardial infarction

Clinical bottom line (level 2a)

  1. Patients with acute coronary syndrome and an elevated troponin level are at increased risk of dying or having a myocardial infarction.
Heidenreich et al: J Am Coll Cardiol 2001; 38 : 478-485
Expires March 2004

The study

Systematic review of all clinical trials and cohort studies of
  • Patients: suspected myocardial ischaemia
  • Intervention: troponin T or troponin I
  • Outcome: death
Articles found in using Medline, Embase, 1966 to 1999 (search terms: troponin and angina, unstable, myocardial infarction or ischemia ) and searching reference lists of retrieved articles, and contacting experts in the field to identify unpublished studies

Selection criteria: by 2 independent reviewers, with a third settling differences
Appraisal criteria: not given
Articles excluded if:
  • only enrolled patients with myocardial infarction
  • case-control studies
  • mortality not reported
  • studies including patients with ST-elevation, unless data on non-ST elevation available separately


27 studies found - 8 reports from 7 clinical trials and 19 cohort studies involving 5360 patients with a troponin T test and 6603 with a troponin I test
Study results were not found to be heterogeneous.

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
death or myocardial infarction 7 months 241/2278 10.6%
(9.32% to 11.8%)		 9
(8 to 11)
death 7 months 337/11562 2.91%
(2.61% to 3.22%)		 34
(31 to 38)

prognostic factor for
death or myocardial infarction 		time to outcome control rate (%) adjusted OR
(95% CI)		 NNF+
(95% CI)
elevated troponin 7 months /
(5.9%) 		2.5
(2.0 to 3.1) 		13
(10 to 19)

prognostic factor for
death 		time to outcome control rate (%) adjusted OR
(95% CI)		 NNF+
(95% CI)
elevated troponin 7 months /
(1.6%) 		3.1
(2.3 to 4.1) 		31
(22 to 50)

  • No significant difference in summary ORs for mortality between troponin T and troponin I was found.

Citation

  1. Heidenreich PA, Alloggiamento T, Melsop K, et al: the prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis. J Am Coll Cardiol 2001; 38 : 478-485
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient acute coronary syndrome
Intervention or Exposure elevated troponin T or troponin I
Outcome death or myocardial infarction