Cardiac Troponins for the Diagnosis of Acute Myocardial Infarction in Chronic Kidney Disease

Autor: Christoph Bickel, Christoph Wanner, Christiane Drechsler, Thomas Münzel, Georg Fette, Stephan Baldus, Stefan Blankenberg, Beatrice von Jeinsen, Karl J. Lackner, Till Keller, Johannes T Neumann, Tanja Zeller, Daniel Kraus, Lars Palapies, Andreas M. Zeiher, Stergios Tzikas
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Cardiac troponin
Nephrology and Kidney
Myocardial Infarction
Diagnostic Testing
macromolecular substances
030204 cardiovascular system & hematology
non‐ST‐segment elevation acute coronary syndrome
urologic and male genital diseases
03 medical and health sciences
0302 clinical medicine
Troponin T
Internal medicine
cohort study
medicine
Humans
Prospective Studies
cardiovascular diseases
ddc:610
030212 general & internal medicine
Myocardial infarction
Renal Insufficiency
Chronic
Original Research
Aged
Kidney in Cardiovascular Disease
business.industry
Troponin I
Middle Aged
Prognosis
medicine.disease
female genital diseases and pregnancy complications
decision aids
Cardiology
biomarker
Biomarker (medicine)
Female
Cardiology and Cardiovascular Medicine
business
Acute Coronary Syndromes
chronic kidney disease
Biomarkers
Follow-Up Studies
Glomerular Filtration Rate
Kidney disease
Cohort study
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background Patients with chronic kidney disease ( CKD ) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction ( AMI ) without ST ‐segment elevation ( NSTE ). In patients with CKD , troponin levels are often chronically elevated, which reduces their diagnostic utility when NSTE ‐ AMI is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with CKD and suspected NSTE ‐ AMI . Methods and Results Two cohorts, 1494 patients from a prospective cohort study with high‐sensitivity troponin I (hs‐ cTnI ) measurements and 7059 cases from a clinical registry with high‐sensitivity troponin T (hs‐ cTnT ) measurements, were analyzed. The prospective cohort comprised 280 CKD patients (estimated glomerular filtration rate 2 ). The registry data set contained 1581 CKD patients. In both cohorts, CKD patients were more likely to have adjudicated NSTE ‐ AMI than non‐ CKD patients. The specificities of hs‐ cTnI and hs‐ cTnT to detect NSTE ‐ AMI were reduced with CKD (0.82 versus 0.91 for hs‐ cTnI and 0.26 versus 0.73 for hs‐ cTnT ) but could be restored by applying optimized cutoffs to either the first or a second measurement after 3 hours. The best diagnostic performance was achieved with an algorithm that incorporates serial measurements and rules in or out AMI in 69% (hs‐ cTnI ) and 55% (hs‐ cTnT ) of CKD patients. Conclusions The diagnostic performance of high‐sensitivity cardiac troponins in patients with CKD with suspected NSTE ‐ AMI is improved by use of an algorithm based on admission troponin and dynamic changes in troponin concentration.
Databáze: OpenAIRE
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