Sensitive Troponin I Assay in Patients with Chest Pain - Association with Significant Coronary Lesions with or Without Renal Failure

Abstract

IntroductionDespite having higher sensitivity as compared to conventional troponins, sensitive troponins have lower specificity, mainly in patients with renal failure.ObjectiveStudy aimed at assessing the sensitive troponin I levels in patients with chest pain, and relating them to the existence of significant coronary lesions.MethodsRetrospective, single-center, observational. This study included 991 patients divided into two groups: with (N = 681) and without (N = 310) significant coronary lesion. For posterior analysis, the patients were divided into two other groups: with (N = 184) and without (N = 807) chronic renal failure. The commercial ADVIA Centaur® TnI-Ultra assay (Siemens Healthcare Diagnostics) was used. The ROC curve analysis was performed to identify the sensitivity and specificity of the best cutoff point of troponin as a discriminator of the probability of significant coronary lesion. The associations were considered significant when p < 0.05.ResultsThe median age was 63 years, and 52% of the patients were of the male sex. The area under the ROC curve between the troponin levels and significant coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or without renal failure, the areas under the ROC curve were 0.703 (95% CI: 0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff points to discriminate the presence of significant coronary lesion were: in the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%); in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%; specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL (sensitivity, 80.6%; specificity, 42%).ConclusionIn patients with chest pain, sensitive troponin I showed a good correlation with significant coronary lesions when its level was greater than 0.605 ng/dL. In patients with chronic renal failure, a significant decrease in specificity was observed in the correlation of troponin levels and severe coronary lesions.

Troponin Cut-Offs for Acute Myocardial Infarction in Patients with Impaired Renal Function—A Systematic Review and Meta-Analysis

“…The 15 studies included for review featured four retrospective studies [ 15 , 16 , 17 , 18 ], eight prospective studies [ 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], and three post hoc analyses [ 26 , 27 , 28 ].…”

“…Two of the post hoc analyses were based on a multicenter study [ 27 , 28 ]. The other studies were single-center studies [ 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 26 ].…”

“…In the majority of studies, renal impairment was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 [ 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 ]. Soeiro et al included patients with a creatinine level >1.5 mg/dL [ 16 ], and Canney et al included patients with an eGFR < 45 mL/min/m 2 [ 18 ]. This cohort study was designed to predict death, hence the lower eGFR.…”

“…Patients most often were suspected of having AMI based on symptoms [ 14 , 15 , 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 ]. Kraus et al defined the measurement of at least two cTn during the study period as surrogate markers for suspicion for AMI [ 28 ].…”

“…There was a heterogeneous definition of AMI in the included articles. Four articles used NSTEMI as an endpoint [ 16 , 23 , 24 , 28 ], Miller-Hodges et al included cardiovascular death within 30 days additionally to NSTEMI diagnosis [ 23 ].…”