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

Session Poster session 1

Speaker Raphael Twerenbold

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Session type : Poster Session

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

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

Citation:
European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 139

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 the prototype Siemens hs-cTnI Vista assay in 1885 patients presenting to the emergency department with symptoms suggestive of AMI, of whom 283 (15%) 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 adjudicated by two independent cardiologists based on hs-cTnT.

Results: AMI was the final diagnosis in 33% (n=93) 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 44%, In patients with KD the diagnostic accuracy at presentation, quantified by the area under the receiver-operator-characteristic curve (AUC), was 0.89. In patients presenting within three hours after the onset of chest pain, the AUC remained high with 0.88. In KD, the optimal hs-cTnI cutoff derived from the ROC curve was 32.0ng/l compared to 12.9ng/l in patients with normal kidney function (standard 99th percentile 9ng/l, provided by the manufacturer).

Conclusions: The investigated prototype hs-cTnI assay has a very high diagnostic accuracy also in KD-patients. Mild elevations are common in non-AMI patients. However, the test-specific optimal cutoff-level in KD-patients seems to be more than three times as high as the standard 99th percentile level.

ClinicalTrials.gov number, NCT00470587

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