A Meta-Analysis and Systematic Review of Cardiac Troponin I vs T in Community Dwelling Adults: Is Specificity at Risk?

Abstract

Background: Cardiac troponin I and T measured by high-sensitivity assays (hs-cTn) are detectable in most ambulatory adults. Hs-cTnI and T may perform differently for prediction of cardiovascular (CV) events. In adults with myopathies and advanced age, hs-cTnT can lose CV specificity. We undertook a meta-analysis of ambulatory studies measuring hs-cTn to determine whether hs-cTnI is a superior predictor of CV outcomes.

Methods: Articles evaluating hs-cTnI or T for incident heart failure (HF), myocardial infarction (MI), CV, and all-cause death in ambulatory adults were screened. Adjusted HRs were extracted standardized as hs-cTn tertile 3 vs 1. Pooled effects were calculated, and heterogeneity assessed. Predefined subgroup analyses for hs-cTnI vs T included age and prevalent CV disease.

Results: A total of 5499 studies were screened and 54 met inclusion criteria with up to 277 498 participants followed for 8.1 ± 4.5 years. Pooled estimates for HF, MI, CV, and all-cause death were reported as 2.30 [95% confidence interval (CI) 2.04, 2.60], 1.64 (95%CI 1.47, 1.86), 2.07 (95%CI 1.82, 2.35), and 1.66 (95%CI 1.51, 1.83). No differences in HRs for subgroups based on hs-cTnI vs hs-cTnT (except all-cause death), age, or prevalent CV disease were observed. Heterogeneity between studies was high with an I2 > 60% for all endpoints for both hs-cTn assays. In a sensitivity analysis of studies measuring both hs-cTnI and T there was also no differences for the prediction of any CV endpoint.

Conclusions: Hs-cTnI and T prediction of multiple CV endpoints are not significantly different irrespective of age and pre-existing CV disease in ambulatory adults.