High-sensitive cardiac troponin for the diagnosis of acute myocardial infarction different chronic kidney disease stages

Background: Chronic kidney disease (CKD) are associated with acute myocardial infarction (AMI). High-sensitive cardiac troponin (hs-cTn) has been evidenced to enhance the early diagnostic accuracy of AMI, but hs-cTn levels are often chronically elevated in CKD patients, which reduces their diagnostic utility. The aim of this study was to derive optimal cutoff-values of hs-cTn levels in patients with CKD and suspected AMI. Methods: In this retrospective paper, a total of 3295 patients with chest pain (2758 in AMI group and 537 in Non-AMI group) were recruited, of whom 23.1% were had an estimated glomerular filtration rate (eGFR) of < 60 mL min(-1) (1.73 m(2))(-1). Hs-cTnI values were measured at presentation. Results: AMI was diagnosed in 83.7% of all patients. The optimal value of hs-TnI in diagnosing AMI was 1.15 ng mL(-1), which were higher in males than females comparing different cutoff-values of subgroups divided by age, gender and renal function, and which increased monotonically with decreasing of eGFR because in patients with CKD without AMI, the correlation between hs-cTnI and renal function is low but significant (r(2) = 0.067, P < 0.001). Conclusions: Different optimal cutoff-values of hs-cTnI in the diagnosis of AMI in patients with CKD were helpful to the clinical diagnosis of AMI in various populations and were higher in males than females, but which was needed to be validated by multicenter randomized controlled clinical studies in the future.

Automated summary

This study aimed to determine the optimal cutoff-values of hs-cTn levels in patients with chronic kidney disease (CKD) and suspected acute myocardial infarction (AMI). It was found that the optimal value of hs-TnI in diagnosing AMI was 1.15 ng mL(-1), which was higher in males than females and increased monotonically with decreasing of estimated glomerular filtration rate (eGFR). Future multicenter randomized controlled clinical studies are needed to validate these findings.