Erin D. Michos, MD, MHS; Lisa M. Wilson, ScM; Hsin-Chieh Yeh, PhD; Zackary Berger, MD, PhDs; Catalina Suarez-Cuervo, MD; Sylvie R. Stacy, MD; Eric B. Bass, MD, MPH
Disclaimer: This article is based on research conducted by the Johns Hopkins University Evidence-based Practice Center under a contract with AHRQ. The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Elisabeth Nannes, Brijesh Patel, Sunil Agrawal, Allen Zhang, Sylvia Wang, and Oluwaseun Shogbesan for their help in reviewing articles and abstracting data.
Financial Support: This article is based on research conducted by the Johns Hopkins University Evidence-based Practice Center under contract with AHRQ (contract 290-2012-00007-I).
Disclosures: Dr. Michos worked under a contract from AHRQ during the conduct of the study and received a grant from the National Institutes of Health outside of the submitted work. Ms. Wilson reports that she worked under a contract from AHRQ during the conduct of the study. Dr. Stacy reports that she worked under a contract from AHRQ during the conduct of the study. Dr. Bass reports receiving a contract from AHRQ for performance of the systematic review. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0743.
Requests for Single Reprints: Erin D. Michos, MD, MHS, Associate Professor of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287; e-mail, email@example.com.
Current Author Addresses: Dr. Michos: Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Carnegie 568, Baltimore, MD 21287.
Ms. Wilson and Dr. Suarez-Cuervo: Johns Hopkins University, Evidence-based Practice Center, 624 North Broadway, Suite 680, Baltimore, MD 21205.
Dr. Yeh: Johns Hopkins University, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287.
Dr. Berger: Johns Hopkins Outpatient Center, 601 North Caroline Street, Suite 7143, Baltimore, MD 21287.
Dr. Stacy: Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room WB602, Baltimore, MD 21205.
Dr. Bass: Johns Hopkins University School of Medicine, 624 North Broadway, Room 680A, Baltimore, MD 21205.
Author Contributions: Conception and design: E.D. Michos, L.M. Wilson, H.C. Yeh, Z. Berger, C. Suarez-Cuervo, E.B. Bass.
Analysis and interpretation of the data: E.D. Michos, L.M. Wilson, Z. Berger, C. Suarez-Cuervo, S.R. Stacy, E.B. Bass.
Drafting of the article: E.D. Michos, H.C. Yeh, Z. Berger, C. Suarez-Cuervo.
Critical revision of the article for important intellectual content: E.D. Michos, L.M. Wilson, Z. Berger, C. Suarez-Cuervo, E.B. Bass.
Final approval of the article: E.D. Michos, L.M. Wilson, Z. Berger, C. Suarez-Cuervo, E.B. Bass.
Provision of study materials or patients: L.M. Wilson, E.B. Bass.
Statistical expertise: L.M. Wilson, H.C. Yeh.
Obtaining of funding: E.B. Bass.
Administrative, technical, or logistic support: E.D. Michos, L.M. Wilson, E.B. Bass.
Collection and assembly of data: E.D. Michos, L.M. Wilson, H.C. Yeh, Z. Berger, C. Suarez-Cuervo, S.R. Stacy.
Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS).
To systematically review the literature on troponin testing in patients with CKD without ACS.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.
Studies examining elevated versus normal troponin levels in patients with CKD without ACS.
Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables.
Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points.
Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up.
In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death.
Agency for Healthcare Research and Quality.
Michos ED, Wilson LM, Yeh H, et al. Prognostic Value of Cardiac Troponin in Patients With Chronic Kidney Disease Without Suspected Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;161:491–501. doi: 10.7326/M14-0743
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Published: Ann Intern Med. 2014;161(7):491-501.
Acute Coronary Syndromes, Cardiology, Chronic Kidney Disease, Coronary Heart Disease, Emergency Medicine.
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