High-Sensitivity Cardiac Troponin and the Risk Stratification of Patients With Renal Impairment Presenting With Suspected Acute Coronary Syndrome

Miller-Hodges, Eve; Anand, Atul; Shah, Anoop; Chapman, Andrew R.; Gallacher, Peter J.; Lee, Kuan Ken; Farrah, Tariq E.; Halbesma, Nynke; Blackmur, James P.; Newby, David E.; Mills, Nicholas L.; Dhaun, Neeraj

doi:10.1161/circulationaha.117.030320

Cited by 77 publications

(55 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…20 In patients with eGFR <60 ml/min/1.73 m 2 , hs-cTnI had comparable sensitivity of rule out (98.6% versus 98.5%; p=1.0), lower specificity of rule in (84.4 versus 91.7%; p<0.001) and lower overall efficacy (54% versus 76%; p<0.001) compared with patients with normal renal function. 20 This also helps highlight the subtle differences between using hs-cTnT and hs-cTnI in the renal population. Subsequent attempts at modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the algorithm.…”

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 83%

“…3 A further large multicentre cohort study of 3,254 patients using the ESC 0/1-hour algorithm in patients with and without renal dysfunction (defined as eGFR <60 ml/min/1.73 m 2 ) found that the prevalence of NSTEMI was higher in the 487 patients with renal dysfunction than in those with normal function (13% versus 30%). 20 That study used both hs-cTnT and hs-cTnI. Compared with patients with normal renal function, hs-cTnT concentrations in patients with renal dysfunction had comparable sensitivity of rule out (100.0% versus 99.2%; p=0.559), lower specificity of rule in (88.7% versus 96.5%; p<0.001) and lower overall efficacy (51% versus 81%; p<0.001).…”

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

“…Compared with patients with normal renal function, hs-cTnT concentrations in patients with renal dysfunction had comparable sensitivity of rule out (100.0% versus 99.2%; p=0.559), lower specificity of rule in (88.7% versus 96.5%; p<0.001) and lower overall efficacy (51% versus 81%; p<0.001). 20 The authors concluded that this was likely the result of the lower percentage of patients with renal dysfunction who were eligible for rule out compared with patients with normal renal function (18% versus 68%; p<0.001). 20 In patients with eGFR <60 ml/min/1.73 m 2 , hs-cTnI had comparable sensitivity of rule out (98.6% versus 98.5%; p=1.0), lower specificity of rule in (84.4 versus 91.7%; p<0.001) and lower overall efficacy (54% versus 76%; p<0.001) compared with patients with normal renal function.…”

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

“…20 The authors concluded that this was likely the result of the lower percentage of patients with renal dysfunction who were eligible for rule out compared with patients with normal renal function (18% versus 68%; p<0.001). 20 In patients with eGFR <60 ml/min/1.73 m 2 , hs-cTnI had comparable sensitivity of rule out (98.6% versus 98.5%; p=1.0), lower specificity of rule in (84.4 versus 91.7%; p<0.001) and lower overall efficacy (54% versus 76%; p<0.001) compared with patients with normal renal function. 20 This also helps highlight the subtle differences between using hs-cTnT and hs-cTnI in the renal population.…”

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

“…Subsequent attempts at modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the algorithm. 20…”

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

See 4 more Smart Citations

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

2019

View full text Add to dashboard Cite

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.

show abstract

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 83%

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

“…Subsequent attempts at modifications of the rule-in and rule-out thresholds did not improve the safety or overall efficacy of the algorithm. 20…”

Section: Cardiac Troponins In Chronic Kidney Disease and End-stage Kimentioning

confidence: 99%

See 3 more Smart Citations

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

2019

View full text Add to dashboard Cite

show abstract

Use of High-Sensitivity Cardiac Troponin in Patients With Kidney Impairment

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

Accuracy of high-sensitive troponin depending on renal function for clinical outcome prediction in patients with acute heart failure

et al. 2021

View full text Add to dashboard Cite

High-sensitive troponin T (hs-TnT) is increasingly used for clinical outcome prediction in patients with acute heart failure (AHF). However, there is an ongoing debate regarding the potential impact of renal function on the prognostic accuracy of hs-TnT in this setting. The aim of the present study was to assess the prognostic value of hs-TnT within 6 h of admission for the prediction of 30-day mortality depending on renal function in patients with AHF. Patients admitted to our institution due to AHF were retrospectively included. Clinical information was gathered from electronic and paper-based patient charts. Patients with myocardial infarction were excluded. A total of 971 patients were enrolled in the present study. A negative correlation between estimated glomerular filtration rate (eGFR) and hsTnT was identified (Pearson r = − 0.16; p < 0.001) and eGFR was the only variable to be independently associated with hsTnT. The area under the curve (AUC) of hs-TnT for the prediction of 30-mortality was significantly higher in patients with an eGFR ≥ 45 ml/min (AUC 0.74) compared to those with an eGFR < 45 ml/min (AUC 0.63; p = 0.049). Sensitivity and specificity of the Youden Index derived optimal cut-off for hs-TnT was higher in patients with an eGFR ≥ 45 ml/min (40 ng/l: sensitivity 73%, specificity 71%) compared to patients with an eGFR < 45 ml/min (55 ng/l: sensitivity 63%, specificity 62%). Prognostic accuracy of hs-TnT in patients hospitalized for AHF regarding 30-day mortality is significantly lower in patients with reduced renal function.

show abstract

High-Sensitivity Cardiac Troponin and the Risk Stratification of Patients With Renal Impairment Presenting With Suspected Acute Coronary Syndrome

Abstract: Supplemental Digital Content is available in the text.

Cited by 77 publications

References 37 publications

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

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

Use of High-Sensitivity Cardiac Troponin in Patients With Kidney Impairment

Accuracy of high-sensitive troponin depending on renal function for clinical outcome prediction in patients with acute heart failure

Contact Info

Product

Resources

About