High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment

Autor: Peter J. Gallacher, Eve Miller-Hodges, Anoop S.V. Shah, Tariq E. Farrah, Nynke Halbesma, James P. Blackmur, Andrew R. Chapman, Philip D. Adamson, Atul Anand, Fiona E. Strachan, Amy V. Ferry, Kuan Ken Lee, Colin Berry, Iain Findlay, Anne Cruickshank, Alan Reid, Alasdair Gray, Paul O. Collinson, Fred S. Apple, David A. McAllister, Donogh Maguire, Keith A.A. Fox, Catriona Keerie, Christopher J. Weir, David E. Newby, Nicholas L. Mills, Neeraj Dhaun, Christopher Tuck, Anda Bularga, Ryan Wereski, Matthew T.H. Lowry, Caelan Taggart, Dennis Sandeman, Catherine L. Stables, Catalina A. Vallejos, Athanasios Tsanas, Lucy Marshall, Stacey D. Stewart, Takeshi Fujisawa, Jean McPherson, Lynn McKinlay, Simon Walker, Ian Ford, Anne Cruikshank, Shannon Amoils, Jennifer Stevens, John Norrie, Jack P.M. Andrews, Alastair Moss, Mohamed S. Anwar, John Hung, Jonathan Malo, Colin M. Fischbacher, Bernard L. Croal, Stephen J. Leslie, Richard A. Parker, Allan Walker, Ronnie Harkess, Tony Wackett, Christopher Weir, Roma Armstrong, Laura Stirling, Claire MacDonald, Imran Sadat, Frank Finlay, Heather Charles, Pamela Linksted, Stephen Young, Bill Alexander, Chris Duncan
Jazyk: angličtina
Rok vydání: 2000
Předmět:
Zdroj: Gallacher, P J, Miller-Hodges, E, Shah, A S V, Farrah, T, Halbesma, N, Blackmur, J P, Chapman, A R, Adamson, P D, Anand, A, Strachan, F E, Ferry, A V, Lee, K K, Berry, C, Findlay, I, Cruickshank, A, Reid, A, Gray, A, Collinson, P O, Apple, F S, McAllister, D A, Maguire, D, Fox, K AA, Keerie, C, Weir, C J, Newby, D E & Mills, N L & Dhaun, N 2022, ' High-Sensitivity Cardiac Troponin and the Diagnosis of Myocardial Infarction in Patients with Renal Impairment ', Kidney International . https://doi.org/10.1016/j.kint.2022.02.019
ISSN: 1523-1755
0085-2538
Popis: The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in the diagnosis of myocardial infarction in patients with kidney impairment is unclear. Here, we describe implementation of hs-cTnI testing on the diagnosis, management, and outcomes of myocardial infarction in patients with and without kidney impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized controlled trial were included in this pre-specified secondary analysis. Kidney impairment was defined as an eGFR under 60mL/min/1.73m2. The index diagnosis and primary outcome of type 1 and type 4b myocardial infarction or cardiovascular death at one year were compared in patients with and without kidney impairment following implementation of hs-cTnI assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 patients (mean age 61 years; 47% women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th centile in 46% and 16% of patients with and without kidney impairment. Implementation increased the diagnosis of type 1 infarction from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without kidney impairment (both significant). Patients with kidney impairment and type 1 myocardial infarction were less likely to undergo coronary revascularization (26% versus 53%) or receive dual anti-platelets (40% versus 68%) than those without kidney impairment, and this did not change post-implementation. In patients with hs-cTnI above the 99th centile, the primary outcome occurred twice as often in those with kidney impairment compared to those without (24% versus 12%, hazard ratio 1.53, 95% confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without kidney impairment.
Databáze: OpenAIRE
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