# Hoog-sensitief troponine I en uitkomsten bij verdenking ACS: JAMA-studie

*geplaatst 2017-11-21 · Algemeen · JAMA · doi 10.1001/jama.2017.17488 · https://hartvaat.nl/2017/11/21/hoog-sensitief-troponine-i-en-uitkomsten-bij-verdenking-acs-jama-studie/*

JAMA-studie naar de associatie van hoog-sensitief troponine I met cardiale uitkomsten bij patiënten met verdenking op ACS. Verfijnt de diagnostische drempelwaarden.

## English: Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome.

This JAMA study examined the prognostic value of high-sensitivity cardiac troponin I at concentrations below conventional MI thresholds, demonstrating a continuous relationship between troponin level and cardiac risk in patients with suspected ACS.

## Abstract (original, from the publication)

IMPORTANCE: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain. OBJECTIVE: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome. DATA SOURCES: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017. STUDY SELECTION: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction. DATA EXTRACTION AND SYNTHESIS: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model. MAIN OUTCOMES AND MEASURES: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data. RESULTS: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death. CONCLUSIONS AND RELEVANCE: 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.

Auteurs: Andrew R Chapman, Kuan Ken Lee, David A McAllister, Louise Cullen, Jaimi H Greenslade, William Parsonage, Andrew Worster, Peter A Kavsak, Stefan Blankenberg, Johannes Neumann, Nils A Sörensen, Dirk Westermann, Madelon M Buijs, Gerard J E Verdel, John W Pickering, Martin P Than, Raphael Twerenbold, Patrick Badertscher, Zaid Sabti, Christian Mueller, Atul Anand, Philip Adamson, Fiona E Strachan, Amy Ferry, Dennis Sandeman, Alasdair Gray, Richard Body, Brian Keevil, Edward Carlton, Kim Greaves, Frederick K Korley, Thomas S Metkus, Yader Sandoval, Fred S Apple, David E Newby, Anoop S V Shah, Nicholas L Mills

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Bron: JAMA, https://doi.org/10.1001/jama.2017.17488. Bijgewerkt 2026-07-03T13:26:17Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.