Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes

Am Heart J. 2000 Dec;140(6):917-27. doi: 10.1067/mhj.2000.111107.


Background: Elevations of cardiac troponin T or I are predictive of adverse outcomes in patients with acute coronary syndromes. However, odds ratios (ORs) vary substantially between studies. This investigation refines these values by means of a meta-analysis.

Methods: Twenty-one studies were suitable. ORs were calculated for short-term (30 days) and long-term (5 months to 3 years) follow-up in patients with ST-segment elevation (ST upward arrow), in those without ST-segment elevation (no ST upward arrow), and in patients with unstable angina. The primary end point was a composite of death or nonfatal myocardial infarction.

Results: A total of 18,982 patients were included. At 30 days, the OR for death or myocardial infarction was 3.44 (95% confidence interval [CI], 2.94-4.03; P <. 00001) for patients with positive troponin. In the ST upward arrow group, troponin elevations carried a 2.86-fold (95% CI, 2.35-3.47; P <.0001) higher risk during short-term follow-up, which was maintained long term. The no-ST upward arrow patients with troponin elevations manifested a 4.93-fold (95% CI, 3.77-6.45; P <.0001) increase of adverse outcomes. The OR for patients with unstable angina and positive troponin was 9.39 (95% CI, 6.46-13.67; P <.0001). For cardiac death alone, the results were similar.

Conclusions: Patients with acute coronary syndromes who have troponin elevations show a substantial increase in risk during short and long-term follow-up.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angina, Unstable / blood*
  • Angina, Unstable / mortality
  • Angina, Unstable / physiopathology
  • Biomarkers / blood
  • Death, Sudden, Cardiac
  • Humans
  • Myocardial Infarction / blood*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Troponin I / blood*
  • Troponin T / blood*


  • Biomarkers
  • Troponin I
  • Troponin T