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Observational Study
. 2024 Jul 24;13(7):546-558.
doi: 10.1093/ehjacc/zuae079.

Diagnosis of acute myocardial infarction in patients with renal failure using high-sensitivity cardiac troponin T

Jonathan D Knott  1 , Olatunde Ola  2 , Laura De Michieli  3 , Ashok Akula  4 , Ramila A Mehta  5 , Marshall Dworak  6 , Erika Crockford  7 , Ronstan Lobo  1 , Joshua Slusser  8 , Nicholas Rastas  6 , Swetha Karturi  9 , Scott Wohlrab  10 , David O Hodge  11 , Eric Grube  12 , Tahir Tak  13 , Charles Cagin  7 , Rajiv Gulati  1 , Yader Sandoval  14 , Allan S Jaffe  1   15
Affiliations
Observational Study

Diagnosis of acute myocardial infarction in patients with renal failure using high-sensitivity cardiac troponin T

Jonathan D Knott et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

Aims: Diagnosing myocardial infarction (MI) in patients with chronic kidney disease (CKD) is difficult as they often have increased high-sensitivity cardiac troponin T (hs-cTnT) concentrations.

Methods and results: Observational US cohort study of emergency department patients undergoing hs-cTnT measurement. Cases with ≥1 hs-cTnT increase > 99th percentile were adjudicated following the Fourth Universal Definition of MI. Diagnostic performance of baseline and serial 2 h hs-cTnT thresholds for ruling-in acute MI was compared between those without and with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). The study cohort included 1992 patients, amongst whom 501 (25%) had CKD. There were 75 (15%) and 350 (70%) patients with CKD and 80 (5%) and 351 (24%) without CKD who had acute MI and myocardial injury. In CKD patients with baseline hs-cTnT thresholds of ≥52, >100, >200, or >300 ng/L, positive predictive values (PPVs) for MI were 36% (95% CI 28-45), 53% (95% CI 39-67), 73% (95% CI 50-89), and 80% (95% CI 44-98), and in those without CKD, 61% (95% CI 47-73), 69% (95% CI 49-85), 59% (95% CI 33-82), and 54% (95% CI 25-81). In CKD patients with a 2 h hs-cTnT delta of ≥10, >20, or >30 ng/L, PPVs were 66% (95% CI 51-79), 86% (95% CI 68-96), and 88% (95% CI 68-97), and in those without CKD, 64% (95% CI 50-76), 73% (95% CI 57-86), and 75% (95% CI 58-88).

Conclusion: Diagnostic performance of standard baseline and serial 2 h hs-cTnT thresholds to rule-in MI is suboptimal in CKD patients. It significantly improves when using higher baseline thresholds and delta values.

Keywords: Chronic kidney disease; High-sensitivity cardiac troponin T; Myocardial infarction.

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Conflict of interest statement

Conflict of interest: A.S.J. has consulted or presently consults for most of the major diagnostics companies, including Beckman-Coulter, Abbott, Siemens, ET Healthcare, Ortho Diagnostics, Roche, Radiometer, Sphingotec, Spinchip, and LumiraDx. He has stock in RCE Technologies. Y.S. has been on advisory boards or consults for Roche Diagnostics, Abbott. Diagnostics, Philips, GE, and Zoll. All other authors have nothing to disclose.

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