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Article

High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome

1
Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
2
German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
3
Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
4
Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
5
German Heart Center Munich, Technische Universität München, Lazarettstraße 36, 80636 Munich, Germany
6
German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany
7
Department of Cardiovascular Diseases, Campus Charité Mitte (CCM), Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
8
Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
9
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
10
Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
*
Author to whom correspondence should be addressed.
B.A. and F.J.-B. contributed equally to the manuscript.
Academic Editor: Sebastiano Gili
J. Clin. Med. 2021, 10(18), 4216; https://doi.org/10.3390/jcm10184216
Received: 8 August 2021 / Revised: 8 September 2021 / Accepted: 14 September 2021 / Published: 17 September 2021
(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75–0.87 versus 0.85, 0.80–0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes. View Full-Text
Keywords: troponin; high-sensitivity; chronic kidney disease; renal insufficiency; myocardial infarction; acute coronary syndrome troponin; high-sensitivity; chronic kidney disease; renal insufficiency; myocardial infarction; acute coronary syndrome
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MDPI and ACS Style

Alushi, B.; Jost-Brinkmann, F.; Kastrati, A.; Cassese, S.; Fusaro, M.; Stangl, K.; Landmesser, U.; Thiele, H.; Lauten, A. High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome. J. Clin. Med. 2021, 10, 4216. https://doi.org/10.3390/jcm10184216

AMA Style

Alushi B, Jost-Brinkmann F, Kastrati A, Cassese S, Fusaro M, Stangl K, Landmesser U, Thiele H, Lauten A. High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome. Journal of Clinical Medicine. 2021; 10(18):4216. https://doi.org/10.3390/jcm10184216

Chicago/Turabian Style

Alushi, Brunilda, Fabian Jost-Brinkmann, Adnan Kastrati, Salvatore Cassese, Massimiliano Fusaro, Karl Stangl, Ulf Landmesser, Holger Thiele, and Alexander Lauten. 2021. "High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome" Journal of Clinical Medicine 10, no. 18: 4216. https://doi.org/10.3390/jcm10184216

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