Outcomes and Management When Using High-sensitivity Versus Conventional Cardiac Troponin in Patients with Acute Chest Pain: A Meta-analysis

BACKGROUND Cardiac troponin (cTn) measurement is pivotal in diagnosing and managing chest pain. High-sensitivity cTn (hs-cTn) assays are slowly supplanting conventional cardiac troponin (c-cTn) use, allowing earlier identification of high-risk patients and diagnosis of myocardial infarction (MI). This improved sensitivity is said to come at the cost of reduced specificity for MI. However, there is a paucity of data regarding the exact impact of this change in patient management and outcomes. OBJECTIVES To compare outcomes and management of patients with chest pain when using hs-cTn versus c-cTn assays as part of the diagnostic and therapeutic strategy. METHODS We conducted a systematic search of studies in all languages across various databases. Inclusion criteria for studies were (1) observational or randomized trials, (2) included adult patients presenting with chest pain, (3) use of hs-cTn or c-cTn in diagnosis, (3) reported data on any of the pre-defined outcomes. The primary outcome was all-cause mortality and secondary outcomes were major adverse cardiovascular events (MACE), MI following index admission, coronary angiography, and revascularization. Study quality was appraised using the Cochrane Tool for Assessing Risk of Bias for randomized trials and the Newcastle-Ottawa Quality Assessment scale for observational studies. Outcomes were analyzed using Review Manager (RevMan) 5.3, employing Mantel-Haenszel analysis of random effects to compute for relative risk and odds ratio. RESULTS Pooled analysis from 5 studies showed that among patients with chest pain, those for whom hs-cTn over c-cTn was used had no difference in all-cause mortality (RR 1.01, 95% CI 0.92-1.12, p=0.82, I2=0%), a significant decrease in MI (RR 0.74, 95% CI 0.63-0.87, p=0.0003) and a trend towards increase in MACE (RR 1.08, 95% CI 1.00-1.16, p=0.04, I2=0%). They were more likely to undergo coronary angiogram (OR 1.52, 95% CI 1.02-2.28, p=0.04) and revascularization (OR 1.34, 95% CI 1.03-1.75, p=0.03). CONCLUSION Use of hs-cTn over conventional cTn led to higher rates of coronary angiography and revascularization, with no reduction in all-cause mortality and no significant MACE reduction.