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Optimal cut-off value of high-sensitivity troponin I in diagnosing myocardial infarction in patients with end-stage renal disease.

ABSTRACT: End-stage renal disease (ESRD) is a major risk factor for cardiovascular disease and the prognosis after myocardial infarction (MI) is dismal. Although cardiac troponin is a key diagnostic test, troponin levels are often elevated in ESRD patients without evidence of MI. Thus, this study attempted to determine the optimal diagnostic value of high-sensitivity troponin I (hsTnI) by dialysis modality in ESRD patients.Medical records of adult dialysis patients who visited tertiary emergency department (ED) were collected retrospectively. Diagnosis of MI was made according to the fourth universal definition of MI. The cut-off values were calculated using a receiver operating characteristic (ROC) curve.Medical records of 1144 patients were analyzed and MI was diagnosed in 82 patients (75 on hemodialysis and 7 on peritoneal dialysis). The optimal cut-off value of hsTnI in hemodialysis patients was 75 ng/L, with 93.33% sensitivity and 60.76% specificity. Area under the curve (AUC) was .870 (95% confidence interval (CI) .833-.906). The optimal cut-off value of hsTnI in peritoneal dialysis patients was 144 ng/L, with 100.00% sensitivity and 83.10% specificity. AUC was .943 (95% CI .893-.992).The dialysis modality should also be considered when diagnosing MI using hsTnI in ESRD patients.

SUBMITTER: Lim E

PROVIDER: S-EPMC7004770 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Optimal cut-off value of high-sensitivity troponin I in diagnosing myocardial infarction in patients with end-stage renal disease.

Lim Eunsoo E Lee Min-Jeong MJ

Medicine 20200101 5

End-stage renal disease (ESRD) is a major risk factor for cardiovascular disease and the prognosis after myocardial infarction (MI) is dismal. Although cardiac troponin is a key diagnostic test, troponin levels are often elevated in ESRD patients without evidence of MI. Thus, this study attempted to determine the optimal diagnostic value of high-sensitivity troponin I (hsTnI) by dialysis modality in ESRD patients.Medical records of adult dialysis patients who visited tertiary emergency departmen ...[more]

PMID: 32000364

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Project description:Glucose is a universally available inexpensive biomarker, which is increased as part of the physiological stress response to acute myocardial infarction (AMI) and may therefore help in its early diagnosis. To test this hypothesis, glucose, high-sensitivity cardiac troponin (hs-cTn) T, and hs-cTnI were measured in consecutive patients presenting with acute chest discomfort to the emergency department (ED) and enrolled in a large international diagnostic study (NCT00470587). Two independent cardiologists centrally adjudicated the final diagnosis using all clinical data, including serial hs-cTnT measurements, cardiac imaging and clinical follow-up. The primary diagnostic endpoint was index non-ST-segment elevation MI (NSTEMI). Prognostic endpoints were all-cause death, and cardiovascular (CV) death or future AMI, all within 730-days. Among 5639 eligible patients, NSTEMI was the adjudicated final diagnosis in 1051 (18.6%) patients. Diagnostic accuracy quantified using the area under the receiver-operating characteristics curve (AUC) for the combination of glucose with hs-cTnT and glucose with hs-cTnI was very high, but not higher versus that of hs-cTn alone (glucose/hs-cTnT 0.930 [95% CI 0.922-0.937] versus hs-cTnT 0.929 [95% CI 0.922-0.937]; glucose/hs-cTnI 0.944 [95% CI 0.937-0.951] versus hs-cTnI 0.944 [95% CI 0.937-0.951]). In early-presenters, a dual-marker strategy (glucose < 7 mmol/L and hs-cTnT < 5/hs-cTnI < 4 ng/L) provided very high and comparable sensitivity to slightly lower hs-cTn concentrations (cTnT/I < 4/3 ng/L) alone, and possibly even higher efficacy. Glucose was an independent predictor of 730-days endpoints. Our results showed that a dual marker strategy of glucose and hs-cTn did not increase the diagnostic accuracy when used continuously. However, a cutoff approach combining glucose and hs-cTn may provide diagnostic utility for patients presenting ≤ 3 h after onset of symptoms, also providing important prognostic information.

Dataset Information

Optimal cut-off value of high-sensitivity troponin I in diagnosing myocardial infarction in patients with end-stage renal disease.

Publications

Optimal cut-off value of high-sensitivity troponin I in diagnosing myocardial infarction in patients with end-stage renal disease.

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