Renal Failure (Jan 2020)

Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency

  • Cheng-Kai Hsu,
  • I-Wen Wu,
  • Yih-Ting Chen,
  • Chia-Huei Peng,
  • Yi-Ju Tseng,
  • Yung-Chang Chen,
  • Ming-Jui Hung,
  • Yu-Cheng Kao

DOI
https://doi.org/10.1080/0886022x.2020.1845732
Journal volume & issue
Vol. 42, no. 1
pp. 1142 – 1151

Abstract

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Background Cardiac troponins are important markers for diagnosis of acute myocardial infarction (AMI) in general population; however, chronically-elevated troponins levels are often seen in patients with renal insufficiency, which reduce their diagnostic accuracy. The aim of our study was to access the diagnostic values of initial high-sensitive cardiac troponin T (hs-cTnT) and relative change of hs-cTnT for AMI in patients with and without renal insufficiency. Methods Cardiac care unit patients with elevated hs-cTnT levels in 2017–2018 were enrolled. Receiver operating characteristic (ROC) curves were used to evaluate initial hs-cTnT levels and relative changes after 3 h of enrollment for diagnosis of AMI in patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (low), and eGFR ≥ 60 mL/min/1.73 m2 (normal). Results Of 359 patients, 240 patients had low eGFR, and 119 patients had normal eGFR. The area under the ROC curve (AUC) for the initial hs-cTnT levels was 0.58 (95% CI, 0.5–0.65, p = 0.053) among patients with low eGFR and 0.54 (95% CI, 0.4–0.67, p = 0.612) among patients with normal eGFR. AUCs for relative changes of hs-cTnT were 0.82 (95% CI, 0.76–0.88, p < 0.001) in patients with low eGFR and 0.82 (95% CI, 0.71–0.91, p < 0.001) in patients with normal eGFR. Optimal cutoff values for the relative changes in hs-cTnT were 16% and 12% in patients with low eGFR and normal eGFR, respectively. Conclusions Relative changes in hs-cTnT levels had better diagnostic accuracy than initial hs-cTnT levels.

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