Typical rise and fall of troponin in (peri-procedural) myocardial infarction: A systematic review

Table 1 Baseline characteristics of included studies

Ref.	Year of publication	NO. of patients	Prevalence MI n (%)	Males with MI n (%)	Diagnostic criteria MI	Tn test	Cut off level	Type of cut off level	Time points measured from
Type 1: Spontaneous MI
Aldous et al[12]	2011	939	200 (21)	NA	Biomarkers	HS-TnT (T)	(T) 0.014 μg/L	(T): 99th	Admission
					ECG	HS-TnI (I)	(I) 0.028 μg/L	(I): 99th
					Imaging
					Symptoms
Aldous et al[13]	2012	385	82 (21)	59 (72)	Biomarkers	TnI (I)	(T): 0.014 μg/L	(T): 99th	Admission
					ECG	HS-TnT (T)	(I): 0.028 μg/L	(I): 99th
					Imaging
					Symptoms
al-Harbi et al[14]	2002	86	51 (59)	46 (90)	ECG	TnI	0.05 ng/mL	99th	Admission
					Symptoms
Apple et al[15]	2009	381	52 (13)	NA	ESC	TnI	0.034 μg/ L	99th	Admission
					ACC
Bahrmann et al[16]	2013	306	38 (12)	23 (61)	Biomarkers	HS-TnT	14 ng/L	99th	Admission
					ECG
					Imaging
					Symptoms
Bertinchant et al[17]	1996	682	48 (7)	41 (85)	WHO	TnI	0.1 μg/L	Cut off	Admission
Biener et al[18]	2013	459	111 (3)	82 (74)	WHO	HS-TnT	14 ng/mL	99th	Admission
					UD
Bjurman et al[19]	2013	1504	1178 (75)	716 (61)	Biomarkers	HS-TnT	40 ng/L	99th	Admission
					ECG
					Imaging
					Symptoms
de Winter et al[20]	2000	131	131 (100)	NA	Biomarkers	TnT	0.1 μg/L	URL	Symptoms
					Symptoms
Falahati et al[21]	1999	327	62 (19)	NA	WHO	TnT	0.20 μg/L	Cut off	Symptoms
Haaf et al[22]	2012	887	127 (14)	87 (69)	Biomarkers	HS-TnT (HT)	(HT): 0.014 μg/L	(HT): 99th	Admission
					ECG	HS-TnI (HI)	(HI): 0.009 μg/L	(HI): 99th
					Imaging	TnI (I)	(I:) 0.009 μg/L	(I:) 99th
					Symptoms
Lucia et al[23]	2001	82	42 (51)	32 (76)	Biomarkers	TnI	1.5 ng/mL	URL	Admission
					ECG
					Symptoms
Mohler et al[24]	1998	100	21 (21)	NA	Biomarkers	TnT	0.1 mg/L	Cut off	Admission
					ECG
					Symptoms
Mueller et al[25]	2012	863	165 (21)	121 (73)	UD	HS-TnT	14 ng/L	99th	Admission
Reichlin et al[26]	2011	836	108 (13)	73 (68)	Biomarkers	Hs-TnT (T)	(T): 0.014 μg/L	(T): 99th	Admission
					ECG	TnI-ultra (I)	(I): 0.04 μg/L	(I): 99th
					Imaging
					Symptoms
Reichlin et al[27]	2013	840	120 (14)	81 (68)	Biomarkers	Hs-TnT (T)	(T): 14 ng/L	(T): 99th	Admission
					ECG	HS-TnI (I)	(I): 9 ng/L	(I): 99th
					Imaging		(I) 9 ng/L	(I): 99th
					Symptoms
Wu[28]	2009	14	4 (29)	4 (100)	NA	TnI-ultra	0.04 μg/L	99th	Admission
Successful reperfusion during acute MI
Abe et al[29]	1994	38	26 (68)	20 (77)	ECG	TnT	0.2 ng/mL	URL	Start treatment
					Symptoms
Apple et al[30]	1996	25	17 (68)	NA	ECG	TnI	3.1 μg/L	URL	Start treatment
					Symptoms
Ferraro et al[9]	2012	87	87 (100)	68 (78)	NA	TnI-ultra	0.04 μg/L	Cut off	Before and after PCI
Ferraro et al[31]	2013	856	360 (42)	253 (70)	Biomarkers	TnI-ultra	40 ng/L	99th	Before and after PCI
					ECG
					Symptoms
Mair et al[32]	1991	172	33 (18)	NA	WHO	TnT	0.5 μg/L	99th	NA
Ricchiuti et al[33]	2000	83	23 (28)	17 (74)	WHO	TnI	0.8 μg/L	URL	End of treatment
Tanasijevic et al[34]	1997	30	19 (63)	15 (79)	NA	TnI	0.6 ng/mL	URL	Admission
Tanasijevic et al[35]	1999	442	344 (78)	258 (75)	NA	TnI	0.4 ng/mL	Cut off	Before and after treatment
Type 4: MI associated with percutaneous coronary intervention
Reimers et al[36]	1997	80	5 (6)	NA	Biomarkers	TnT	0.1 μg/L	URL	Before PCI and after
					ECG
					Imaging
Type 5: MI associated with coronary artery bypass grafting
Abdel Aziz et al[37]	2000	50	14 (28)	14 (100)	Biomarkers	TnT	10 μg/L	Cut off	Declamping
					ECG
Alyanakian et al[38]	1998	41	5 (12)	NA	ECG	TnI	0.6 μg/L	URL	Start CPB
					Imaging
Benoit et al[39]	2001	260	8 (3)	NA	Biomarkers	TnI	0.6 μg/L	URL	Before OR, end of ECC
					ECG
					Imaging
Fellahi et al[40]	1999	102	7 (7)	4 (57)	ECG	TnI	0.6 ng/mL	Cut off	Admission ICU
Katus et al[41]	1991	45	5 (11)	NA	ECG	TnI	0.5 mg/L	URL	After surgery
Lim et al[42]	2011	28	9 (32)	7 (78)	UD	TnI-ultra	0.06 μg/L	99th	End of surgery
Mair et al[43]	1994	119	10 (8)	9	ECG	TnI (I)	(I): 0.10 μg/L	(I): URL	Declamping
						TnT (T)	(T): 0.10 μg/L	(T): Cut off
Thielmann et al[44]	2004	55	55 (100)	26 (74)	Biomarkers	TnI	0.5 ng/mL	Cut off	Declamping
					ECG
Thielmann et al[45]	2005	94	94 (100)	67 (71)	Biomarkers	TnI	20 ng/mL	Cut off	Declamping
					ECG

99^th: 99^th percentile; ACC: American College of Cardiology; CPB: Cardiopulmonary bypass; ECC: Extracorporeal circulation; ESC: European Society of Cardiology Criteria for MI; HS-TnI: High sensitive TnI; HS-TnT: High sensitive TnT; MI: Myocardial infarction; NA: Not available; PCI: Percutaneous coronary intervention; Tn: Troponin; UD: Universal definition of MI; URL: Upper reference limit; WHO: World Health Organization Criteria for MI.

Table 2 Quality of the included articles based on a modified QUADAS tool

Ref.	1	2	3	4	5	6	7
Type 1: Spontaneous MI
Aldous et al[12]	+	?	-	+	+	?	-
Aldous et al[13]	+	+	+	+	+	?	?
al-Harbi et al[14]	+	?	+	+	+	?	?
Apple et al[15]	+	+	+	+	+	?	?
Bahrmann et al[16]	+	+	-	+	-	?	+
Bertinchant et al[17]	+	+	+	+	+	?	?
Biener et al[18]	+	+	+	+	+	?	?
Bjurman et al[19]	+	+	?	+	+	-	?
de Winter et al[20]	+	-	+	+	+	?	+
Falahati et al[21]	+	+	?	+	+	?	?
Haaf et al[22]	+	+	-	+	+	?	+
Lucia et al[23]	+	-	?	+	+	?	?
Mohler et al[24]	+	+	+	+	+	?	?
Mueller et al[25]	+	+	+	+	+	?	?
Reichlin et al[26]	+	+	-	+	+	?	?
Reichlin et al[27]	+	+	+	+	+	+	+
Wu[28]	+	+	+	+	+	?	?
Successful reperfusion during acute MI
Abe et al[29]	-	+	-	+	-	?	-
Apple et al[30]	?	?	-	?	?	?	?
Ferraro et al[9]	-	?	+	+	-	-	?
Ferraro et al[31]	+	-	?	+	+	?	?
Mair et al[32]	+	+	+	+	+	?	-
Ricchiuti et al[33]	+	+	+	+	?	?	?
Tanasijevic et al[34]	?	?	?	-	?	-	?
Tanasijevic et al[35]	-	-	-	?	-	+	?
Type 4: MI associated with percutaneous coronary intervention
Reimers et al[36]	-	+	+	+	?	?	?
Type 5: MI associated with coronary artery bypass grafting
Abdel Aziz et al[37]	+	-	+	+	-	?	?
Alyanakian et al[38]	+	+	+	+	-	?	?
Benoit et al[39]	+	+	+	+	-	?	?
Fellahi et al[40]	+	-	+	+	-	?	+
Katus et al[41]	+	-	+	+	-	?	?
Lim et al[42]	+	+	+	+	-	+	+
Mair et al[43]	-	+	+	+	+	?	?
Thielmann et al[44]	+	+	+	+	+	?	?
Thielmann et al[45]	+	+	+	+	+	?	?

MI: Myocardial infarction. 1: Representativeness of the spectrum; 2: Acceptable reference standard; 3: Acceptable delay between tests; 4: Partial verification avoided; 5: Relevant clinical; 6: Uninterpretable results reported; 7: Withdrawals explained information.