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

Session Ischaemic heart disease - the renal angle

Speaker Raphael Twerenbold

Event : ESC Congress 2013

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

Authors : R Twerenbold (Basel,CH), T Reichlin (Basel,CH), PH Haaf (Basel,CH), S Sou (Basel,CH), T Hochgruber (Basel,CH), M Mueller (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
R. Twerenbold1 , T. Reichlin1 , P.H. Haaf1 , S. Sou1 , T. Hochgruber1 , M. Mueller1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland ,

Citation:
European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 813

Purpose: The recent introduction of high-sensitive 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 particular high-risk subgroup.

Methods: We conducted an international multicenter study to examine the diagnostic accuracy of a prototype hs-cTnI assay (Abbott Architect iSTAT high-sensitive cTnI) in 2298 consecutive patients presenting to the emergency department with symptoms suggestive of AMI, of whom 391 (17%) 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 35% (n=138) 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 30%, In patients with KD the diagnostic accuracy at presentation, quantified by the area under the receiver-operator-characteristic curve (AUC), was significantly greater for hs-cTnI as compared to the standard cTnT assay (AUC for hs-cTnI, 0.88 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 hs-cTnI over conventional cTnT was even more pronounced (AUC 0.84 vs. 0.70, p=0.01). In KD, the optimal hs-cTnI cutoff derived from the ROC curve was 25 ng/l compared to 11 ng/l in patients with normal kidney function (official 99th percentile 16 ng/l; provided by the manufacturer).

Conclusions: AMI is very frequent among KD-patients presenting with acute chest pain. The Abbott hs-cTnI assay has a high diagnostic accuracy in these patients and is superior to a conventional cTnT-assay. Mild elevations are common in non-AMI patients. Of note, the optimal cutoff-level in KD-patients seems to be more than twice as high as in patients with normal kidney function.

ClinicalTrials.gov number, NCT00470587.

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