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Optimal cutoff-value of siemens cardiac troponin I ultra assay in patients with kidney disease for the early diagnosis of acute myocardial infarction

Session Poster session 6

Speaker Raphael Twerenbold

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care
  • Session type : Poster Session

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

Authors:
R. Twerenbold1 , T. Reichlin2 , K. Wildi1 , P. Haaf1 , S. Druey1 , 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 ), 984-985

Purpose: The recent introduction of more sensitive cardiac troponin (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 Siemens cTnI Ultra assay in 2695 consecutive patients presenting to the emergency department with symptoms suggestive of AMI, of whom 419 (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 diagnostic accuracy was further compared to a conventional, less sensitive cTn assay (Roche Troponin T fourth generation). The final diagnosis was adjudicated by two independent cardiologists based on hs-cTnT.

Results: AMI was the final diagnosis in 36% (n=150) of all KD-patients as compared to 18% in patients with normal kidney function (p<0.001). Among KD-patients with other diagnoses than AMI, baseline cTnI-levels were elevated above the 99thpercentile in 19%, In patients with KD the diagnostic accuracy at presentation, quantified by the area under the receiver-operator-characteristic curve (AUC), was significantly greater for Siemens cTnI as compared to the standard cTnT assay (AUC for cTnI, 0.87 vs. AUC for the standard assay, 0.82, p=0.02). In patients presenting within three hours after the onset of chest pain, the superiority of Siemens cTnI Ultra over conventional cTnT was even more pronounced (AUC 0.86 vs. 0.72, p=0.006). In KD, the optimal cTnI cutoff derived from the ROC curve was 46 ng/l compared to 19 ng/l in patients with normal kidney function (standard 99th percentile 40 ng/l, provided by the manufacturer).

Conclusions: The investigates sensitive cTnI assay has a very high diagnostic accuracy also in KD-patients and is superior to a conventional cTnT-assay. Mild elevations are common in non-AMI patients. The optimal cutoff-level in KD-patients seems to be around the 99th percentile of a standard population, whereas the optimal cutoff-level in patients with normal kidney function tends to be only half of the suggested cutoff-value.

ClinicalTrials.gov number, NCT00470587

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