Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: A systematic review

Sylvie R. Stacy, Catalina Suarez-Cuervo, Zackary Berger, Lisa Wilson, Hsin Chieh Yeh, Eric B Bass, Erin Donnelly Michos

Research output: Contribution to journalArticle

Abstract

Background: Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging.

Purpose: To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD.

Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.

Study Selection: Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD.

Data Extraction: Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE).

Data Synthesis: Twenty-three studies met inclusion criteria. The sensitivity of troponin T for ACS diagnosis ranged from 71% to 100%, and specificity ranged from 31% to 86% (6 studies; low SOE). The sensitivity and specificity of troponin I ranged from 43% to 94% and from 48% to 100%, respectively (8 studies; low SOE). No studies examined how troponin levels affect management strategies. Twelve studies analyzed prognostic value. Elevated levels of troponin I or troponin T were associated with higher risk for shortterm death and cardiac events (low SOE). A similar trend was observed for long-term mortality with troponin I (low SOE), but less evidence was found for long-term cardiac events for troponin I and long-term outcomes for troponin T (insufficient SOE). Patients with advanced CKD tended to have worse prognoses with elevated troponin I levels than those without them (moderate SOE).

Limitation: Studies were heterogeneous in design and in ACS definitions and adjudication methods.

Conclusion: In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis, but the diagnostic utility is limited by varying estimates of sensitivity and specificity.

Primary Funding Source: Agency for Healthcare Research and Quality.

Original languageEnglish (US)
Pages (from-to)502-512
Number of pages11
JournalAnnals of Internal Medicine
Volume161
Issue number7
DOIs
StatePublished - Oct 7 2014

Fingerprint

Troponin
Acute Coronary Syndrome
Chronic Renal Insufficiency
Troponin I
Troponin T
Sensitivity and Specificity
Mortality
Information Storage and Retrieval
Health Services Research
MEDLINE
Serum

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

@article{1b0623805e5642dc94999c976e5b74fa,
title = "Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: A systematic review",
abstract = "Background: Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging.Purpose: To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD.Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.Study Selection: Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD.Data Extraction: Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE).Data Synthesis: Twenty-three studies met inclusion criteria. The sensitivity of troponin T for ACS diagnosis ranged from 71{\%} to 100{\%}, and specificity ranged from 31{\%} to 86{\%} (6 studies; low SOE). The sensitivity and specificity of troponin I ranged from 43{\%} to 94{\%} and from 48{\%} to 100{\%}, respectively (8 studies; low SOE). No studies examined how troponin levels affect management strategies. Twelve studies analyzed prognostic value. Elevated levels of troponin I or troponin T were associated with higher risk for shortterm death and cardiac events (low SOE). A similar trend was observed for long-term mortality with troponin I (low SOE), but less evidence was found for long-term cardiac events for troponin I and long-term outcomes for troponin T (insufficient SOE). Patients with advanced CKD tended to have worse prognoses with elevated troponin I levels than those without them (moderate SOE).Limitation: Studies were heterogeneous in design and in ACS definitions and adjudication methods.Conclusion: In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis, but the diagnostic utility is limited by varying estimates of sensitivity and specificity.Primary Funding Source: Agency for Healthcare Research and Quality.",
author = "Stacy, {Sylvie R.} and Catalina Suarez-Cuervo and Zackary Berger and Lisa Wilson and Yeh, {Hsin Chieh} and Bass, {Eric B} and Michos, {Erin Donnelly}",
year = "2014",
month = "10",
day = "7",
doi = "10.7326/M14-0746",
language = "English (US)",
volume = "161",
pages = "502--512",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "7",

}

TY - JOUR

T1 - Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome

T2 - A systematic review

AU - Stacy, Sylvie R.

AU - Suarez-Cuervo, Catalina

AU - Berger, Zackary

AU - Wilson, Lisa

AU - Yeh, Hsin Chieh

AU - Bass, Eric B

AU - Michos, Erin Donnelly

PY - 2014/10/7

Y1 - 2014/10/7

N2 - Background: Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging.Purpose: To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD.Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.Study Selection: Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD.Data Extraction: Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE).Data Synthesis: Twenty-three studies met inclusion criteria. The sensitivity of troponin T for ACS diagnosis ranged from 71% to 100%, and specificity ranged from 31% to 86% (6 studies; low SOE). The sensitivity and specificity of troponin I ranged from 43% to 94% and from 48% to 100%, respectively (8 studies; low SOE). No studies examined how troponin levels affect management strategies. Twelve studies analyzed prognostic value. Elevated levels of troponin I or troponin T were associated with higher risk for shortterm death and cardiac events (low SOE). A similar trend was observed for long-term mortality with troponin I (low SOE), but less evidence was found for long-term cardiac events for troponin I and long-term outcomes for troponin T (insufficient SOE). Patients with advanced CKD tended to have worse prognoses with elevated troponin I levels than those without them (moderate SOE).Limitation: Studies were heterogeneous in design and in ACS definitions and adjudication methods.Conclusion: In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis, but the diagnostic utility is limited by varying estimates of sensitivity and specificity.Primary Funding Source: Agency for Healthcare Research and Quality.

AB - Background: Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging.Purpose: To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD.Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.Study Selection: Studies examining elevated versus normal troponin levels in terms of their diagnostic performance in detection of ACS, effect on ACS management strategies, and prognostic value for mortality or cardiovascular events after ACS among patients with CKD.Data Extraction: Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE).Data Synthesis: Twenty-three studies met inclusion criteria. The sensitivity of troponin T for ACS diagnosis ranged from 71% to 100%, and specificity ranged from 31% to 86% (6 studies; low SOE). The sensitivity and specificity of troponin I ranged from 43% to 94% and from 48% to 100%, respectively (8 studies; low SOE). No studies examined how troponin levels affect management strategies. Twelve studies analyzed prognostic value. Elevated levels of troponin I or troponin T were associated with higher risk for shortterm death and cardiac events (low SOE). A similar trend was observed for long-term mortality with troponin I (low SOE), but less evidence was found for long-term cardiac events for troponin I and long-term outcomes for troponin T (insufficient SOE). Patients with advanced CKD tended to have worse prognoses with elevated troponin I levels than those without them (moderate SOE).Limitation: Studies were heterogeneous in design and in ACS definitions and adjudication methods.Conclusion: In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis, but the diagnostic utility is limited by varying estimates of sensitivity and specificity.Primary Funding Source: Agency for Healthcare Research and Quality.

UR - http://www.scopus.com/inward/record.url?scp=84908102129&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908102129&partnerID=8YFLogxK

U2 - 10.7326/M14-0746

DO - 10.7326/M14-0746

M3 - Article

C2 - 25111593

AN - SCOPUS:84908102129

VL - 161

SP - 502

EP - 512

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 7

ER -