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Predicting mortality with cardiac troponins: recent insights from meta-analyses

Authors
  • Lippi, Giuseppe1
  • Cervellin, Gianfranco2,
  • Sanchis-Gomar, Fabian3,
  • 1 University of Verona, Piazzale LA Scuro , (Italy)
  • 2 University Hospital of Parma, Italy , (Italy)
  • 3 University of Valencia and INCLIVA Biomedical Research Institute, Spain , (Spain)
Type
Published Article
Journal
Diagnosis
Publisher
De Gruyter
Publication Date
Oct 17, 2019
Volume
8
Issue
1
Pages
37–49
Identifiers
DOI: 10.1515/dx-2019-0061
Source
De Gruyter
Keywords
License
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Abstract

The introduction of cardiac troponin (cTn) testing in clinical practice has been one of the most important breakthroughs that have occurred in the recent history of laboratory medicine. Although it is now uncontestable that cTn values are essential for diagnosing acute coronary syndrome (ACS), solid evidence is also emerging that assessment of either cardiac troponin I (cTnI) or T (cTnT) may provide valuable prognostic information in the general healthy population, as well as in patients with a vast array of cardiac and extra-cardiac diseases. We have hence performed a critical review of the scientific literature for identifying meta-analyses which have investigated the potential contribution of cTns in predicting the risk of death in health and disease. According to the articles identified with our research, we can conclude that increased cTn values may be considered independent risk factors for all-cause mortality in the general population, as well as in patients with ACS, in those undergoing revascularization procedures, or with stable coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF). Measurement of cTn may then be helpful for stratifying the mortality risk in non-cardiac hospitalized patients, in those with critical illness or sepsis, syncope, stroke, acute aortic dissection, pulmonary diseases, brain injury, renal failure, vascular and non-cardiac surgery. Although this evidence has notable clinical implications, the cost-effectiveness of population screening with high-sensitivity (hs) cTn immunoassays has not been proven so far.

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