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Optimal cutoff-value of a prototype high-sensitivity cardiac troponin I assay by Beckman-Coulter in patients with kidney disease for the early diagnosis of acute myocardial infarction

Session Biomarkers and diagnosis of acute coronary syndrome in the emergency department

Speaker Raphael Twerenbold

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease and Comorbidities
  • Session type : Rapid Fire Abstracts

Authors : R Twerenbold (Basel,CH), T Reichlin (Boston,US), K Wildi (Basel,CH), M Rubini Gimenez (Basel,CH), P Hillinger (Basel,CH), P Haaf (Basel,CH), C Jaeger (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

R. Twerenbold1 , T. Reichlin2 , K. Wildi1 , M. Rubini Gimenez1 , P. Hillinger1 , P. Haaf1 , C. Jaeger1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland , 2Brigham and Women's Hospital, Department of Medicine, Cardiovascular Division - Boston - United States of America ,

European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 887

Purpose: The recent introduction of high-sensitivity cardiac troponin (hs-cTn) assays improved the early diagnosis of acute myocardial infarction (AMI). However, its diagnostic utility has never been tested in patients with kidney disease (KD), who are known to have elevated levels of cTn already in the absence of AMI, which may lead to a lower diagnostic value of more sensitive cTn in this high-risk subgroup.

Methods: We conducted an international multicenter study to examine the diagnostic accuracy of a prototype hs-cTnI assay by Beckman-Coulter in 1155 patients presenting to the emergency department with symptoms suggestive of AMI, of whom 190 (16%) were determined to have KD (MDRD GFR <60ml/min/1.73m2) and to derive the optimal cutoff value for the diagnosis of AMI in patients with KD. The final diagnosis was centrally adjudicated by two independent cardiologists based on hs-cTnT.

Results: AMI was the final diagnosis in 33% (n=63) of all KD-patients as compared to 17% in patients with normal kidney function (p<0.001). Among KD-patients with other diagnoses than AMI, baseline hs-cTnI-levels were elevated above the 99thpercentile in 54%, In patients with KD the diagnostic accuracy at presentation, quantified by the area under the receiver-operator-characteristic curve (AUC), was 0.89 (95%CI for AUC, 0.84-0.94). In patients presenting within three hours after the onset of chest pain, the AUC was 0.82 (95%CI 0.70-0.93). In KD, the optimal hs-cTnI cutoff derived from the ROC curve was 25.9ng/l compared to 11.1ng/l in patients with normal kidney function (official 99th percentile 9ng/l, provided by the manufacturer).

Conclusions: The investigated prototype hs-cTnI assay has a high diagnostic accuracy also in KD-patients. Mild elevations are common in non-AMI patients. However, the optimal cutoff-level in KD-patients seems to be about three times as high as the officially recommended cutoff. number, NCT00470587

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