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High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome

(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary...

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Autores principales: Alushi, Brunilda, Jost-Brinkmann, Fabian, Kastrati, Adnan, Cassese, Salvatore, Fusaro, Massimiliano, Stangl, Karl, Landmesser, Ulf, Thiele, Holger, Lauten, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471888/
https://www.ncbi.nlm.nih.gov/pubmed/34575325
http://dx.doi.org/10.3390/jcm10184216
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author Alushi, Brunilda
Jost-Brinkmann, Fabian
Kastrati, Adnan
Cassese, Salvatore
Fusaro, Massimiliano
Stangl, Karl
Landmesser, Ulf
Thiele, Holger
Lauten, Alexander
author_facet Alushi, Brunilda
Jost-Brinkmann, Fabian
Kastrati, Adnan
Cassese, Salvatore
Fusaro, Massimiliano
Stangl, Karl
Landmesser, Ulf
Thiele, Holger
Lauten, Alexander
author_sort Alushi, Brunilda
collection PubMed
description (1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75–0.87 versus 0.85, 0.80–0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes.
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spelling pubmed-84718882021-09-28 High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome Alushi, Brunilda Jost-Brinkmann, Fabian Kastrati, Adnan Cassese, Salvatore Fusaro, Massimiliano Stangl, Karl Landmesser, Ulf Thiele, Holger Lauten, Alexander J Clin Med Article (1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75–0.87 versus 0.85, 0.80–0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes. MDPI 2021-09-17 /pmc/articles/PMC8471888/ /pubmed/34575325 http://dx.doi.org/10.3390/jcm10184216 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Alushi, Brunilda
Jost-Brinkmann, Fabian
Kastrati, Adnan
Cassese, Salvatore
Fusaro, Massimiliano
Stangl, Karl
Landmesser, Ulf
Thiele, Holger
Lauten, Alexander
High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
title High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
title_full High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
title_fullStr High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
title_full_unstemmed High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
title_short High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
title_sort high-sensitivity cardiac troponin t in patients with severe chronic kidney disease and suspected acute coronary syndrome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471888/
https://www.ncbi.nlm.nih.gov/pubmed/34575325
http://dx.doi.org/10.3390/jcm10184216
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