Coronary disease & ACSDiagnostic or prognostic study
Improving the diagnostic performance of troponin assays for acute myocardial infarction in renal impairment
- Diagnostic performance analysis of troponin assays
- four acute tertiary care hospitals in London, UK
- 2010–2017
Authors' conclusion
The diagnostic performance of an unadjusted troponin cut-off for AMI falls with worsening renal function. We propose consideration of eGFR specific cut-offs to support more effective triage and early management of suspected AMI in patients with renal impairment.
Study context
- Population
- Patients with troponin measurement at four acute tertiary care hospitals in London, UK, between 2010 and 2017patients included
- Participants
- 221,175 patients
- Comparison
- Troponin for diagnosing acute myocardial infarction (AMI), stratified by estimated glomerular filtration rate (eGFR)
Performance
As reported in the abstract
Median age
65 years (IQR 49-79)
eGFR <60 mL/min/1.73 m 2
20.6%
Diagnosis of AMI
6.4%
Further findings
Relationship between eGFR and troponin in patients without AMI
- Inverse log-linear relationship between eGFR and troponin
Diagnostic performance for AMI by eGFR
- eGFR>90, C-statistic (best)
- 0.93
- eGFR<15, C-statistic (worst)
- 0.81
False positive rate of high-sensitive troponin T at conventional cut-off of 14 ng/L, eGFR 15–60 mL/min/1.73 m 2
- False positive rates
- 68-93%
eGFR-specific cut-offs restricting false positive rate to 15%
- eGFR 45-60: cut-off
- 73 ng/L
- eGFR 45-60: detection rate
- 73%
- eGFR 30-45: cut-off
- 112 ng/L
- eGFR 30-45: detection rate
- 70%
- eGFR 15-30: cut-off
- 184 ng/L
- eGFR 15-30: detection rate
- 68%
Original publication
Summarised from the published abstract; every number is checked against it