High-sensitive cardiac troponin for the diagnosis of acute myocardial infarction in different chronic kidney disease stages

Abstract

Background: Chronic kidney disease (CKD) are associated with acute myocardial infarction (AMI). High-sensitive cardiac troponin (hs-cTn) has been evidenced to enhance the early diagnostic accuracy of AMI, but hs-cTn levels are often chronically elevated in CKD patients, which reduces their diagnostic utility. The aim of this study was to derive optimal cutoff-values of hs-cTn levels in patients with CKD and suspected AMI.

Methods: In this retrospective paper, a total of 3295 patients with chest pain (2758 in AMI group and 537 in Non-AMI group) were recruited, of whom 23.1% were had an estimated glomerular filtration rate (eGFR) of < 60 mL min^-1 (1.73 m²)^-1. Hs-cTnI values were measured at presentation.

Results: AMI was diagnosed in 83.7% of all patients. The optimal value of hs-TnI in diagnosing AMI was 1.15 ng mL^-1, which were higher in males than females comparing different cutoff-values of subgroups divided by age, gender and renal function, and which increased monotonically with decreasing of eGFR because in patients with CKD without AMI, the correlation between hs-cTnI and renal function is low but significant (r² = 0.067, P < 0.001).

Conclusions: Different optimal cutoff-values of hs-cTnI in the diagnosis of AMI in patients with CKD were helpful to the clinical diagnosis of AMI in various populations and were higher in males than females, but which was needed to be validated by multicenter randomized controlled clinical studies in the future.

Keywords: Acute myocardial infarction; Chronic kidney disease; Estimated glomerular filtration rate; High-sensitivity cardiac troponin.

Fig. 1

Flow charts for the inclusion of study subjects. ACS acute coronary syndrome, AMI acute myocardial infarction, hs-cTnI high-sensitive cardiac troponin I, eGFR estimated glomerular filtration rate

Fig. 2

The association of hs-cTnI with measures of renal function in patients with CKD [eGFR < 60 mL min⁻¹ (1.73 m²)⁻¹] by Pearson’s correlation coefficient, and compared hs-cTnI levels between patients with or without AMI. There was a low but significant correlation between hs-cTnI and renal function in CKD patients without AMI (r² = 0.067, P < 0.001), but there was no correlation in CKD patients with AMI (r² = 0.003, P = 0.23). Furthermore, we found that CKD could result in the elevation of hs-cTnI without AMI. AMI acute myocardial infarction, eGFR estimated glomerular filtration rate, hs-cTnI high-sensitive cardiac troponin I, CKD chronic kidney disease

Fig. 3

ROC curve for diagnosis of AMI in the total study population. The optimal cutoff-value for diagnosis of AMI in all suspicious patients, which appeared to be an hs-TnI level of 1.15 ng mL⁻¹ with 82.5% sensitivity and 95.4% specificity. AUC was 0.924 [95% CI (0.914, 0.933)]. AMI acute myocardial infarction, hs-cTnI high-sensitive cardiac troponin I; AUC area under the curve, ROC receiver-operating characteristic

Fig. 4

ROC curve for diagnosis of AMI divided by age, gender and renal function. a Male patients younger than 60 years with eGFR ≥ 60 mL min⁻¹ (1.73 m²)⁻¹, Cut-off = 0.24 ng mL⁻¹ with 91.6% sensitivity and 100.0% specificity. AUC = 0.984 [95% CI (0.973, 0.991)]. b Male patients aged 60 or above with eGFR ≥ 60 mL min⁻¹ (1.73 m²)⁻¹, Cut-off = 0.31 ng mL⁻¹ with 90.9% sensitivity and 100.0% specificity. AUC = 0.962 [95% CI (0.949, 0.973)]. c Female patients younger than 60 years with eGFR ≥ 60 mL min⁻¹ (1.73 m²)⁻¹, Cut-off = 0.27 ng mL⁻¹ with 93.2% sensitivity and 100.0% specificity. AUC = 0.979 [95% CI (0.941, 0.995)]. d Female patients aged 60 or above with eGFR ≥ 60 mL min⁻¹ (1.73 m²)⁻¹, Cut-off = 0.27 ng mL⁻¹ with 91.0% sensitivity and 100.0% specificity. AUC = 0.946 [95% CI (0.918, 0.966)]. e Male patients younger than 60 years with 30 ≤ eGFR < 60 mL min⁻¹·(1.73 m²)⁻¹, Cut-off = 0.72 ng mL⁻¹ with 81.4% sensitivity and 100.0% specificity. AUC = 0.869 [95% CI (0.772, 0.936)]. f Male patients aged 60 or above with 30 ≤ eGFR < 60 mL min⁻¹·(1.73 m²)⁻¹, Cut-off = 0.50 ng mL⁻¹ with 89.5% sensitivity and 100.0% specificity. AUC = 0.959 [95% CI (0.932, 0.978)]. g Female patients aged 60 or above with 30 ≤ eGFR < 60 mL min⁻¹·(1.73 m²)⁻¹, Cut-off = 0.59 ng mL⁻¹ with 91.4% sensitivity and 100.0% specificity. AUC = 0.952 [95% CI (0.910, 0.979)]. h Male patients aged 60 or above with 15 ≤ eGFR < 30 mL min⁻¹ (1.73 m²)⁻¹, Cut-off = 2.61 ng mL⁻¹ with 80.4% sensitivity and 92.1% specificity. AUC = 0.907 [95% CI (0.827, 0.958)]. i Female Patients aged 60 or above with 15 ≤ eGFR < 30 mL min⁻¹ (1.73 m²)⁻¹, Cut-off = 1.90 ng mL⁻¹ with 89.3% sensitivity and 92.1% specificity. AUC = 0.943 [95% CI (0.846, 0.987)]. AMI acute myocardial infarction, hs-cTnI high-sensitive cardiac troponin I, AUC area under the curve, ROC receiver-operating characteristic, eGFR estimated glomerular filtration rate