Influence of Age and Renal Function on High-Sensitivity Cardiac Troponin T Diagnostic Accuracy for the Diagnosis of Acute Myocardial Infarction

High sensitive TROponin levels In Patients with Chest pain and kidney disease: A multicenter registry — The TROPIC study

“…In the present population, accuracy of troponin I was higher than that of T, stressing the need for an accurate choice of assays according to a specific population of interest. Performance of hs-cTnT was lower than in the recent study of ChenevierGobeaux [16], but median values of clearance in that study (75.3; 62.7-91.7 mL/min/1.73 m 2 ) were significantly higher than in this study (49: 35-53), thus explaining limited performance. Moreover both for troponin T and I, accuracy was higher in patients with less severely reduced renal clearance, stressing the need to test these results in a prospective way, to increase evidence about troponin assays in patients with CKD.…”

“…Only a few studies [16] have tested the accuracy of hs-cTn in ACS settings, but patients included had a median clearance higher than 60 mL/min/m 2 , consequently limiting their applicability into everyday practice.…”

Value of Highly Sensitive Troponin T for Diagnosis of Acute Coronary Syndrome in Chronic Kidney Disease Patients

“…Chenevier-Gobeaux, et al (2013) studied 367 patients with low estimated glomerular filtration rate (eGFR) alter the diagnostic performance of high-sensitivity cardiac troponin T (HScTnT) in a prospective multicentric study. And found that older age, but not low eGFR, was an independent predictive factor of an elevated HScTnT at admission and adapted thresholds of highly sensitive troponin T are required for an accurate diagnosis of STEMI/NSTEMI in patients aged ≥70 and in those with low eGFR (10) . Our study results showed that eGFR calculated by CKD-EPI equation 2009 and MDRD formula was significantly lower in the study group compared to the control group with p value was less than 0.05.…”

“…Serum highly-sensitive troponin T levels in patients with renal dysfunction may be higher than the normal population, resulting in higher cutoff points for diagnosis of acute coronary syndrome (9) . Persistently elevated highly-sensitive troponin T is frequently observed among patients with chronic kidney disease (10) . The prevalence of increased highly-sensitive troponin T values among patients with chronic renal failure in the absence of clinically suspected ischemia may be as high as 53% (11) .…”

Cardiac troponins: State of the (He)Art

“…However, the increase in sensitivity due to lower cut-off values came at the expense of a decreased specificity 12 : Elevations of cardiac troponin levels turned out not to be specific for acute myocardial infarction, but were also associated with several other acute and chronic conditions like myocarditis, heart failure, pulmonary embolism, stroke, stable coronary artery disease, type 2 diabetes mellitus, decreased renal function and as the result of prolonged exercise 32,[71][72][73][74][75][76][77][78][79][80] . Since the cut-off values of the current diagnostic algorithms are specifically aimed at not missing subjects with acute myocardial infarction (thus the sensitivity is rather high), this may lead to an overdiagnosis or even an overtreatment of patients with persistently elevated cardiac troponin concentrations 81,82 . Therefore, the further optimization of interpretation of cardiac troponin concentrations in diagnosis seems to be indicated and prompts questions like: How may these conditions affect the diagnosis of acute myocardial infarction?…”