Diagnosis of acute myocardial infarction in patients with renal failure using high-sensitivity cardiac troponin T
Authors' conclusion
Diagnostic performance of standard baseline and serial 2 h hs-cTnT thresholds to rule-in MI is suboptimal in CKD patients. It significantly improves when using higher baseline thresholds and delta values.
Study context
- Population
- US ED patients undergoing high-sensitivity cardiac troponin T (hs-cTnT) measurement
- Participants
- 1,992 patients
- Comparison
- hs-cTnT rule-in thresholds in chronic kidney disease (CKD) vs no CKD
- CKDn = 501
- Outcome
- PPV of baseline and serial 2 h hs-cTnT thresholds for ruling in acute myocardial infarction (MI) (Fourth Universal Definition)
Methodological detailsobservational cohort
- Observational cohort
Performance
As reported in the abstract
PPV for MI
| Test or model | Baseline ≥52 ng/L PPV | Baseline >100 ng/L PPV | Baseline >200 ng/L PPV | Baseline >300 ng/L PPV | 2 h delta ≥10 ng/L PPV | 2 h delta >20 ng/L PPV | 2 h delta >30 ng/L PPV |
|---|---|---|---|---|---|---|---|
| CKD | 36% (95% CI 28-45) | 53% (95% CI 39-67) | 73% (95% CI 50-89) | 80% (95% CI 44-98) | 66% (95% CI 51-79) | 86% (95% CI 68-96) | 88% (95% CI 68-97) |
| No CKD | 61% (95% CI 47-73) | 69% (95% CI 49-85) | 59% (95% CI 33-82) | 54% (95% CI 25-81) | 64% (95% CI 50-76) | 73% (95% CI 57-86) | 75% (95% CI 58-88) |
Baseline ≥52 ng/L PPV
CKD36% (95% CI 28-45)
No CKD61% (95% CI 47-73)
Baseline >100 ng/L PPV
CKD53% (95% CI 39-67)
No CKD69% (95% CI 49-85)
Baseline >200 ng/L PPV
CKD73% (95% CI 50-89)
No CKD59% (95% CI 33-82)
Baseline >300 ng/L PPV
CKD80% (95% CI 44-98)
No CKD54% (95% CI 25-81)
2 h delta ≥10 ng/L PPV
CKD66% (95% CI 51-79)
No CKD64% (95% CI 50-76)
2 h delta >20 ng/L PPV
CKD86% (95% CI 68-96)
No CKD73% (95% CI 57-86)
2 h delta >30 ng/L PPV
CKD88% (95% CI 68-97)
No CKD75% (95% CI 58-88)
Further findings
| Outcome | CKD | No CKD |
|---|---|---|
| Acute MI and myocardial injury | ||
| Acute MI | 75 (15%) | 80 (5%) |
| Myocardial injury | 350 (70%) | 351 (24%) |
Original publication
Diagnosis of acute myocardial infarction in patients with renal failure using high-sensitivity cardiac troponin T. Eur Heart J Acute Cardiovasc Care. Published 2 July 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →