Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction

TY - JOUR

T1 - Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction

AU - Twerenbold, Raphael

AU - Wildi, Karin

AU - Jaeger, Cedric

AU - Gimenez, Maria Rubini

AU - Reiter, Miriam

AU - Reichlin, Tobias

AU - Walukiewicz, Astrid

AU - Gugala, Mathias

AU - Krivoshei, Lian

AU - Marti, Nadine

AU - Moreno Weidmann, Zoraida

AU - Hillinger, Petra

AU - Puelacher, Christian

AU - Rentsch, Katharina

AU - Honegger, Ursina

AU - Schumacher, Carmela

AU - Zurbriggen, Felicitas

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Campodarve, Isabel

AU - Bassetti, Stefano

AU - Osswald, Stefan

AU - Mueller, Christian

N1 - Publisher Copyright: © 2015 American Heart Association, Inc.

PY - 2015

Y1 - 2015

N2 - Background - It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. Methods and Results - In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease-estimated glomerular filtration rate <60 mL·min-1·1.73 m-2). The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography and serial levels of high-sensitivity cTnT. Acute myocardial infarction was the final diagnosis in 36% of all patients with renal dysfunction. Among patients with renal dysfunction and elevated baseline cTn levels (≥99th percentile), acute myocardial infarction was the most common diagnosis for all assays (range, 45%-80%). In patients with renal dysfunction, diagnostic accuracy at presentation, quantified by the area under the receiver-operator characteristic curve, was 0.87 to 0.89 with no significant differences between the 7 more sensitive cTn assays and further increased to 0.91 to 0.95 at 3 hours. Overall, the area under the receiver-operator characteristic curve in patients with renal dysfunction was only slightly lower than in patients with normal renal function. The optimal receiver-operator characteristic curve-derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9-3.4). Conclusions - More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.

AB - Background - It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. Methods and Results - In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease-estimated glomerular filtration rate <60 mL·min-1·1.73 m-2). The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography and serial levels of high-sensitivity cTnT. Acute myocardial infarction was the final diagnosis in 36% of all patients with renal dysfunction. Among patients with renal dysfunction and elevated baseline cTn levels (≥99th percentile), acute myocardial infarction was the most common diagnosis for all assays (range, 45%-80%). In patients with renal dysfunction, diagnostic accuracy at presentation, quantified by the area under the receiver-operator characteristic curve, was 0.87 to 0.89 with no significant differences between the 7 more sensitive cTn assays and further increased to 0.91 to 0.95 at 3 hours. Overall, the area under the receiver-operator characteristic curve in patients with renal dysfunction was only slightly lower than in patients with normal renal function. The optimal receiver-operator characteristic curve-derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9-3.4). Conclusions - More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.

KW - High-sensitivity

KW - Kidney

KW - Myocardial infarction

KW - Renal insufficiency

KW - Troponin

UR - http://www.scopus.com/inward/record.url?scp=84935473393&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.114.014245

DO - 10.1161/CIRCULATIONAHA.114.014245

M3 - SCORING: Journal article

C2 - 25948542

AN - SCOPUS:84935473393

VL - 131

SP - 2041

EP - 2050

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

IS - 23

ER -