Prediction of Hemodynamically Significant Coronary Artery Disease Using Troponin I in Hemodialysis Patients Presenting with Chest Pain: A Case-Control Study

Abstract

Objectives: Controversy exists regarding utility of cardiac troponin I (cTnI) in predicting significant coronary artery disease (CAD) in hemodialysis (HD) patients with chest pain and no acute ischemia on electrocardiogram (non-ST segment elevation myocardial infarction, non-STEMI). We sought to determine if cTnI elevation predicts significant CAD (>70% stenosis) in these patients. Methods: Ninety patients with non-STEMI referred for cardiac catheterization were included, divided equally into HD and non-HD groups. Results: Mean age and baseline characteristics were not significantly different between groups, except for left ventricular hypertrophy which was higher in HD patients (56 vs. 27%, p = 0.012). Initial cTnI correlated with obstructive CAD and was stratified into <0.3 and >0.3 ng/ml. By logistic regression, cTnI >0.3 ng/ml was not predictive of CAD in HD patients [odds ratio = 0.87 (95% CI 0.19–4.0), p = 0.8], while non-HD patients had an increased risk of CAD if first cTnI was >0.3 ng/ml [odds ratio = 1.461 (95% CI 1.01–2.11), p = 0.04] as expected. Sensitivity, specificity, negative and positive predictive values of cTnI in predicting obstructive CAD were better in non-HD patients. Conclusion: cTnI in these patients had no predictive value for obstructive CAD. This contrasts with the general population, suggesting a higher index of suspicion for high-grade CAD irrespective of cTnI levels in HD patients.

Understanding cardiac biomarkers in end‐stage kidney disease: Frequently asked questions and the promise of clinical application

“…In a study of African American patients, 95% of patients with elevated cTnI had a >70% stenosis of at least one vessel at angiography 77 and the overall sensitivity was 73% and specificity 83% for this outcome. A case–control study of patients with a non‐STEMI plus coronary artery disease at diagnostic coronary angiography demonstrated poorer sensitivity and specificity for detecting a coronary lesion >70% in the cases undergoing haemodialysis compared with the controls with normal kidney function 78 …”

“…A case-control study of patients with a non-STEMI plus coronary artery disease at diagnostic coronary angiography demonstrated poorer sensitivity and specificity for detecting a coronary lesion >70% in the cases undergoing haemodialysis compared with the controls with normal kidney function. 78 Although studies of acute coronary syndromes in dialysis patients are few and include small numbers of patients, the following points should be appreciated when confronted with a dialysis patient with suggestive symptoms and an elevated cardiac troponin: (i) the pre-test probability of cardiovascular disease is high; (ii) a rise compared with a previous troponin strongly supports the presence of significant myocardial ischaemia; (iii) a rise during that specific presentation strongly supports the presence of significant myocardial ischaemia, but waiting for a second sample will delay revascularization if it is needed; and (iv) any dialysis patient with elevated troponin has a greater risk of dying than one with troponin below the reference cut-off.…”

Association between troponin I level and cardiovascular risk factors in asymptomatic hemodialysis patients

“…[ 2 ] There is considerable controversy that exists in the significance of cardiac troponins in predicting cardiac injury and ischemia in chronic renal failure patients, especially in patients on HD. [ 3 4 ] In this study, we evaluated cardiac troponin I (cTnI) and its correlation to cardiovascular risk factors in our HD patients.…”