High-Sensitivity Cardiac Troponin and the Risk Stratification of Patients with Renal Impairment Presenting with Suspected Acute Coronary Syndrome.
Circulation. 2017 Oct 04;:
Authors: Miller-Hodges EV, Anand A, Shah ASV, Chapman AR, Gallacher PJ, Lee KK, Farrah TE, Halbesma N, Blackmur JP, Newby DE, Mills NL, Dhaun N
Background -High-sensitivity cardiac troponin testing may improve the risk-stratification and diagnosis of myocardial infarction, but concentrations can be challenging to interpret in patients with renal impairment and the effectiveness of testing in this group is uncertain. Methods -In a prospective multi-center study of consecutive patients with suspected acute coronary syndrome, we evaluated the performance of high-sensitivity cardiac troponin I in those with and without renal impairment (estimated glomerular filtration rate 99(th) centile and renal impairment were at greater risk of subsequent myocardial infarction or cardiac death than those with normal renal function (24% vs. 10%, adjusted hazard ratio 2.19, 95%CI 1.54-3.11). Conclusions -In suspected acute coronary syndrome, high-sensitivity cardiac troponin identified fewer patients with renal impairment as low-risk and more as high-risk, but with lower specificity for type 1 myocardial infarction. Irrespective of diagnosis, patients with renal impairment and elevated cardiac troponin concentrations had two-fold greater risk of a major cardiac event compared to those with normal renal function, and should be considered for further investigation and treatment. Clinical Trial Registration -URL: https://clinicaltrials.gov Unique Identifier: NCT01852123.
PMID: 28978551 [PubMed - as supplied by publisher]