Abstract 14984: Intra-Individual Changes in Concentration Improve Diagnostic Utility of High Sensitive Troponin I and T to Identify an Acute Myocardial Infarction in Patients With Chronic Kidney Disease
Introduction and Aim: Cardiac troponins (cTn) are the gold standard to diagnose acute myocardial infarction (AMI) in the absence of ST-segment elevation. In chronic kidney disease (CKD), troponin levels are elevated irrespective of AMI, reducing the diagnostic utility of troponin cut-offs for the diagnosis of AMI. The aim of this study was to analyze the additional diagnostic information of intra-individual changes in high sensitive cardiac troponin I (hs-cTnI) and troponin T (hs-cTnT) levels of patients with CKD and suspected AMI.
Methods: A study dataset of 1,494 patients and a clinical dataset of 4,478 patients presenting with suspected AMI were used in the analyses. In the study dataset, 73 (26%) out of 280 patients with CKD (estimated glomerular filtration rate < 60 ml/min/1,73 m2) had the final diagnosis of AMI. In the clinical dataset, 280 (25.8%) out of 1,085 patients with CKD had the final diagnosis AMI. hs-cTnI was measured upon admission and 3 hours after admission and hs-cTnT upon admission and approximately 3.3 hours after admission.
Results: In both datasets, hs-cTn levels at admission and after three hours were significantly higher in CKD patients. Both hs-cTnI and hs-cTnT showed good relative intra-individual stability in CKD patients without AMI. Based on the change in hs-cTn levels within 3 hours, we derived an algorithm to rule-in and rule-out AMI in CKD patients. In patients presenting with normal hs-cTn on admission demonstrating a change of hs-Tn of less than 2.8fold of the baseline hs-cTnI level or less than 2.1fold of the baseline hs-cTnT level, NSTE-AMI can be ruled-out with negative predictive values of 0.98 (0.94, 1) and 0.96 (0.92, 0.98), respectively. Conversely, patients presenting with elevated baseline hs-cTn levels and cTn change of more than 2.8/2.1fold are highly suspicious for NSTE-AMI with positive predictive value of 0.89 (0.65, 0.99) and 0.76 (0.69, 0.82), respectively.
Conclusion: In the absence of AMI, troponin levels are stable in all patients regardless of the presence or absence of CKD. Intra-individual changes outperform static cut-offs in all patients and can be used in CKD patients to rule in or out AMI with high confidence.
Author Disclosures: B. von Jeinsen: None. D. Kraus: None. S. Tzikas: None. L. Palapies: None. T. Zeller: None. C. Bickel: None. G. Fette: None. K.J. Lackner: None. S. Baldus: None. S. Blankenberg: None. T. Muenzel: None. C. Wanner: None. A.M. Zeiher: None. T. Keller: None.
- © 2016 by American Heart Association, Inc.