0/1-Hour Triage Algorithm for Myocardial Infarction in Patients With Renal Dysfunction

Twerenbold, Raphael; Badertscher, Patrick; Boeddinghaus, Jasper; Nestelberger, Thomas; Wildi, Karin; Puelacher, Christian; Sabti, Zaid; Giménez, María Rubini; Tschirky, Sandra; Lavallaz, Jeanne du Fay de; Kozhuharov, Nikola; Sazgary, Lorraine; Mueller, Deborah; Breidthardt, Tobias; Strebel, Ivo; Flores, Dayana; Shrestha, Samyut; Miró, Òscar; Martín‐Sánchez, Francisco Javier; Morawiec, Beata; Pařenica, Jiří; Geigy, Nicolas; Keller, Dagmar I.; Rentsch, Katharina; Eckardstein, Arnold von; Oßwald, Stefan; Reichlin, Tobias

doi:10.1161/circulationaha.117.028901

Cited by 119 publications

(107 citation statements)

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“…Advantageous Predictors of ACS Evaluation was a prospective multicenter ED study in Europe that assessed the diagnostic performance of using highly sensitive (hs)-cTnT and hs-cTnI at zero and 1 h after presentation to the ED [2]. These markers were sensitive in ruling out NSTEMI in CKD patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 , but the specificity to rule-in disease was lower than in patients with normal kidney function (88.7 vs. 96.5% for hs-cTnT, 84.4 vs. 91.7% for hs-cTnI).…”

Section: Cardiac Troponinmentioning

confidence: 99%

“…The investigators tested slightly higher concentrations as the cutoff, but this yielded little improvement at the cost of decreased sensitivity in higher risk CKD patients. They concluded that the higher prevalence of NSTEMI in the CKD population drives a higher positive predictive value and the same hc-cTn cutoff should be used until better diagnostic tools become available [2].…”

Section: Cardiac Troponinmentioning

confidence: 99%

“…Atypical presentations of acute coronary syndrome (ACS) such as silent myocardial infarction (MI), nonspecific electrocardiogram changes due to comorbidities such as left ventricular hypertrophy or electrolyte abnormalities, and absence of accurate cardiac biomarkers not affected by kidney function have made ACS diagnosis in this patient population quite challenging [1]. A prospective study of emergency department (ED) visits found that CKD patients who presented with acute chest pain had non-ST elevation MI (NSTEMI) more than twice as often as patients with normal kidney function [2].…”

Section: Introductionmentioning

confidence: 99%

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Utility of Cardiac Biomarkers in the Setting of Kidney Disease

Savoj

Becerra

Kim

et al. 2019

Nephron

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Cardiovascular disease is prevalent in patients with chronic kidney disease (CKD) and responsible for approximately half of all CKD-related deaths. Unfortunately, the presence of CKD can lead to a challenging interpretation of cardiac biomarkers essential in accurate diagnosis and prompt management of heart failure and acute coronary syndrome. There is growing interest in novel cardiac biomarkers that may improve diagnostic accuracy reflecting myocardial injury, inflammation, and remodeling. Interpretation of these biomarkers in CKD can be complicated, since elevated levels may not reflect myocardial injury or wall tension but rather decreased urinary clearance with retention of solutes and/or overall CKD-associated chronic inflammation. In this review, we discuss the latest data on major and emerging cardiac biomarkers including B-type natriuretic peptide, troponin, suppression of tumorigenicity 2, growth and differentiation factor-15, galectin-3, and matrix gla protein, and their diagnostic and prognostic utility in the CKD population.

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Section: Cardiac Troponinmentioning

confidence: 99%

Section: Cardiac Troponinmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of Cardiac Biomarkers in the Setting of Kidney Disease

Savoj

Becerra

Kim

et al. 2019

Nephron

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show abstract

“…In a large American retrospective study, 26.6% of patients diagnosed with ACS also had AKI (defined in that study as a rise in serum creatinine of 0.3 mg/dl). 21 Prompt diagnosis of ACS in patients also diagnosed with AKI is important to ensure appropriate, tailored management for both conditions.…”

Section: Acute Coronary Syndrome Biomarker and Acute Kidney Injurymentioning

confidence: 99%

Troponins, Acute Coronary Syndrome and Renal Disease: From Acute Kidney Injury Through End-stage Kidney Disease

2019

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The diagnosis of acute coronary syndromes (ACS) is heavily dependent on cardiac biomarker assays, particularly cardiac troponins. ACS, particularly non-ST segment elevation MI, are more common in patients with acute kidney injury, chronic kidney disease (CKD) and end-stage kidney disease (ESKD), are associated with worse outcomes than in patients without kidney disease and are often difficult to diagnose and treat. Hence, early accurate diagnosis of ACS in kidney disease patients is important using easily available tools, such as cardiac troponins. However, the diagnostic reliability of cardiac troponins has been suboptimal in patients with kidney disease due to possible decreased clearance of troponin with acute and chronic kidney impairment and low levels of troponin secretion due to concomitant cardiac muscle injury related to left ventricular hypertrophy, inflammation and fibrosis. This article reviews the metabolism and utility of cardiac biomarkers in patients with acute and chronic kidney diseases. Cardiac troponins are small peptides that accumulate in both acute and chronic kidney diseases due to impaired excretion. Hence, troponin concentrations rise and fall with acute kidney injury and its recovery, limiting their use in the diagnosis of ACS. Troponin concentrations are chronically elevated in CKD and ESKD, are associated with poor prognosis and decrease the sensitivity and specificity for diagnosis of ACS. Yet, the evidence indicates that the use of high-sensitivity troponins can confirm or exclude a diagnosis of ACS in the emergency room in a significant proportion of kidney disease patients; those patients in whom the results are equivocal may need longer in-hospital assessment.

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“…Although concern has been raised regarding the safety of the 0/1-hour algorithm in patients with renal dysfunction, in a recent work, Twerenbold R showed the 0/1-hour algorithms using either high-sensitivity cardiac troponin T or troponin I can rule out MI rapidly and safely. 12 In addition, recent studies have shown combining HEART score or combining hs-cTnT and hs-cTnI may further enhance the accuracy of the rapid diagnosis algorithm. 13,14 Despite the rapid development of various high sensitivity troponin testing based accelerated diagnosis system, the implementation of the newly developed algorithms in ED have been slow.…”

mentioning

confidence: 99%