High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Clinical and Laboratory Assessment
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. Baseline and Periprocedural Characteristics
3.2. Values of hs-cTnT during Serial Sampling
3.3. Diagnostic Performance of Hs-cTnT in Patients with Severe CKD
3.4. Optimal Cutoff Levels of Hs-cTnT for the Early Diagnosis of NSTE-ACS Requiring Revascularization
3.5. Outcomes at 30 Days and One Year of Follow-Up
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Revascularization | ||||
---|---|---|---|---|
Total n = 290 | No n = 68 | Yes n = 222 | p-Value | |
NSTEMI type 1 | 156 (53.8) | 0 (0) | 156 (70.3) | <0.01 |
NSTEMI type 2 | 55 (19.0) | 10 (14.7) | 45 (20.3) | 0.38 |
Hypertensive crisis | 32 (11.0) a | 7 (10.3) b | 25 (11.3) c | 1.00 |
Tachy-/bradyarrhythmia | 28 (9.7) a | 7 (10.3) b | 21 (9.5) c | 0.82 |
Unstable angina | 50 (17.2) | 34 (50) | 16 (7.2) | <0.01 |
Cardiac, non-coronary | 14 (4.8) | 9 (13.2) | 5 (2.2) | 0.001 |
Takotsubo syndrome | 1 (0.3) | 1 (1.5) | 0 (0) | 0.23 |
Pulmonary embolism | 1 (0.3) | 0 (0) | 1 (0.5) | 1.00 |
Endo-/myocarditis | 4 (1.8) | 0 (0) | 4 (1.8) | 0.58 |
Heart failure non-ischemic | 8 (2.8) | 8 (11.7) | 0 (0) | <0.01 |
Non-cardiac cause | 6 (2.1) | 6 (8.8) | 0 (0) | <0.01 |
Unknown | 9 (3.1) | 9 (13.2) | 0 (0) | <0.01 |
Hs-cTnT Cutoff (ng/L) | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | Multiples of the 99 Percentile | Multiples of CKD vs. Control | |
---|---|---|---|---|---|---|---|
0 h | |||||||
99th percentile a | 14 | 98 (95–99) | 10 (2–19) | 79 (74–85) | 50 (19–81) | - | - |
ROC optimized | 55 | 83 (77–88) | 65 (52–77) | 89 (85–94) | 52 (39–64) | 3.9 | 4.0 |
Sensitivity ≥ 90% | 37 | 90 (85–94) | 48 (35–63) | 86 (81–91) | 57 (30–64) | 2.6 | 2.7 |
Specificity ≥ 80% | 95 | 70 (63–77) | 80 (68–91) | 92 (88–97) | 43 (33–53) | 6.8 | 7.0 |
Peak prior to angiography | |||||||
ROC optimized | 95 | 84 (79–90) | 78 (66–89) | 93 (89–97) | 59 (46–70) | 6.8 | 3.8 |
Sensitivity ≥ 90% | 71 | 90 (86–95) | 60 (45–73) | 89 (84–93) | 63 (49–77) | 5.0 | 2.8 |
Specificity ≥ 80% | 112 | 79 (73–85) | 82 (71–92) | 94 (90–98) | 53 (41–64) | 8.0 | 4.5 |
0 h + |∆0 h–3 h| | |||||||
0 h ≥ 55 ng/L or | 98 (91–100) | 55 (25–82) | 93 (83–97) | 86 (42–99) | |||
3 h-change ≥ 4 ng/L |
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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
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 StyleAlushi, 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
APA StyleAlushi, B., Jost-Brinkmann, F., Kastrati, A., Cassese, S., Fusaro, M., Stangl, K., Landmesser, U., Thiele, H., & Lauten, A. (2021). High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome. Journal of Clinical Medicine, 10(18), 4216. https://doi.org/10.3390/jcm10184216