High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome

(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary...

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Bibliographic Details
Published in:Journal of clinical medicine 2021-09, Vol.10 (18), p.4216
Main Authors: Alushi, Brunilda, Jost-Brinkmann, Fabian, Kastrati, Adnan, Cassese, Salvatore, Fusaro, Massimiliano, Stangl, Karl, Landmesser, Ulf, Thiele, Holger, Lauten, Alexander
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Cardiovascular disease
Chronic obstructive pulmonary disease
Clinical medicine
Coronary vessels
Electrocardiography
Heart attacks
Hemodialysis
Independent sample
Intervention
Kidney diseases
Laboratories
Medical imaging
Medical records
Mortality
Patients
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Summary:(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75–0.87 versus 0.85, 0.80–0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm10184216