Sylvie R. Stacy, MD, MPH *; Catalina Suarez-Cuervo, MD *; Zackary Berger, MD, PhD; Lisa M. Wilson, ScM; Hsin-Chieh Yeh, PhD; Eric B. Bass, MD, MPH; Erin D. Michos, MD, MHS
Disclaimer: 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. Stacy reports that she worked under a contract from AHRQ during the conduct of the study. Ms. Wilson reports that she worked under a contract from AHRQ during the conduct of the study. Dr. Bass reports receiving a contract from AHRQ for the conduct of the study. Dr. Michos worked under a contract from AHRQ during the conduct of the study and a grant from the National Institutes of Health outside of the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0746.
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, Carnegie 568, Baltimore, MD 21287; e-mail, email@example.com.
Current Author Addresses: Dr. Stacy: Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room WB602, Baltimore, MD 21205.
Dr. Suarez-Cuervo and Ms. Wilson: Johns Hopkins University, Evidence-based Practice Center, 624 North Broadway, Suite 680, Baltimore, MD 21205.
Dr. Berger: Johns Hopkins Outpatient Center, 601 North Caroline Street, Suite 7143, Baltimore, MD 21287.
Dr. Yeh: Johns Hopkins University, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287.
Dr. Bass: Johns Hopkins University School of Medicine, 624 North Broadway, Room 680A, Baltimore, MD 21205.
Dr. Michos: Johns Hopkins University School of Medicine, 600 North Wolfe Street, Carnegie 568, Baltimore, MD 21287.
Author Contributions: Conception and design: C. Suarez-Cuervo, Z. Berger, L.M. Wilson, H.C. Yeh, E.B. Bass, E.D. Michos.
Analysis and interpretation of the data: S.R. Stacy, C. Suarez-Cuervo, Z. Berger, L.M. Wilson, H.C. Yeh, E.B. Bass, E.D. Michos.
Drafting of the article: S.R. Stacy, C. Suarez-Cuervo, Z. Berger, E.D. Michos.
Critical revision of the article for important intellectual content: C. Suarez-Cuervo, Z. Berger, L.M. Wilson, H.C. Yeh, E.B. Bass, E.D. Michos.
Final approval of the article: S.R. Stacy, C. Suarez-Cuervo, Z. Berger, L.M. Wilson, E.B. Bass, E.D. Michos.
Provision of study materials or patients: L.M. Wilson, E.B. Bass.
Statistical expertise: H.C. Yeh.
Obtaining of funding: E.B. Bass.
Administrative, technical, or logistic support: L.M. Wilson, E.B. Bass, E.D. Michos.
Collection and assembly of data: S.R. Stacy, C. Suarez-Cuervo, Z. Berger, L.M. Wilson, E.D. Michos.
Patients with chronic kidney disease (CKD) have high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging.
To evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014.
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.
Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE).
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 short-term 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).
Studies were heterogeneous in design and in ACS definitions and adjudication methods.
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.
Agency for Healthcare Research and Quality.
Stacy SR, Suarez-Cuervo C, Berger Z, et al. Role of Troponin in Patients With Chronic Kidney Disease and Suspected Acute Coronary Syndrome: A Systematic Review. Ann Intern Med. 2014;161:502–512. doi: 10.7326/M14-0746
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Published: Ann Intern Med. 2014;161(7):502-512.
Acute Coronary Syndromes, Cardiology, Chronic Kidney Disease, Coronary Heart Disease, Emergency Medicine.
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