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

  • Giuseppe Lippi EMAIL logo , Gianfranco Cervellin and Fabian Sanchis-Gomar
Published/Copyright: October 17, 2019
Diagnosis
From the journal Diagnosis Volume 8 Issue 1

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.

Keywords: death; mortality; prediction; troponin
Corresponding author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University of Verona, Piazzale LA Scuro, 37134 Verona, Italy
aGianfranco Cervellin and Fabian Sanchis-Gomar have equal senior authorship in this work.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2019-08-20
Accepted: 2019-09-26
Published Online: 2019-10-17
Published in Print: 2021-02-23

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Driving on a highway to hell I found the stairway to heaven. A mentorship lecture intermixed with rock music and a quiz
  4. Review
  5. Updated overview on the interplay between obesity and COVID-19
  6. Mini Review
  7. Challenges and opportunities for integrating genetic testing into a diagnostic workflow: heritable long QT syndrome as a model
  8. Opinion Papers
  9. Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
  10. Interpreting clinical and laboratory tests: importance and implications of context
  11. Predicting mortality with cardiac troponins: recent insights from meta-analyses
  12. Guidelines and Recommendations
  13. Operational measurement of diagnostic safety: state of the science
  14. Original Articles
  15. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
  16. Pyoderma gangrenosum underrepresentation in non-dermatological literature
  17. Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
  18. Assessing physical examination skills using direct observation and volunteer patients
  19. Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
  20. Letters to the Editor
  21. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
  22. Letter in response to Vanstone paper on diagnostic intuition
  23. Corrigenda
  24. Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  25. Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
  26. Acknowledgment
  27. Acknowledgment
https://doi.org/10.1515/dx-2019-0061
Keywords for this article
death; mortality; prediction; troponin

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Driving on a highway to hell I found the stairway to heaven. A mentorship lecture intermixed with rock music and a quiz
  4. Review
  5. Updated overview on the interplay between obesity and COVID-19
  6. Mini Review
  7. Challenges and opportunities for integrating genetic testing into a diagnostic workflow: heritable long QT syndrome as a model
  8. Opinion Papers
  9. Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
  10. Interpreting clinical and laboratory tests: importance and implications of context
  11. Predicting mortality with cardiac troponins: recent insights from meta-analyses
  12. Guidelines and Recommendations
  13. Operational measurement of diagnostic safety: state of the science
  14. Original Articles
  15. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
  16. Pyoderma gangrenosum underrepresentation in non-dermatological literature
  17. Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
  18. Assessing physical examination skills using direct observation and volunteer patients
  19. Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
  20. Letters to the Editor
  21. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
  22. Letter in response to Vanstone paper on diagnostic intuition
  23. Corrigenda
  24. Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  25. Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
  26. Acknowledgment
  27. Acknowledgment
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