Diagnostic performance of high-sensitive troponin T in patients with renal insufficiency

Pfortmueller, Carmen A.; Funk, Georg-Christian; Marti, Grischa; Leichtle, Alexander B.; Fiedler, Georg M.; Schwarz, Christoph; Exadaktylos, Aristomenis K.; Lindner, Gregor (2013). Diagnostic performance of high-sensitive troponin T in patients with renal insufficiency. American journal of cardiology, 112(12), pp. 1968-1972. Elsevier 10.1016/j.amjcard.2013.08.028

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In the present study, we wanted to (1) evaluate whether high-sensitive troponin T levels correlate with the grade of renal insufficiency and (2) test the accuracy of high-sensitive troponin T determination in patients with renal insufficiency for diagnosis of acute myocardial infarction (AMI). In this cross-sectional analysis, all patients who received serial measurements of high-sensitive troponin T from August 1, 2010, to October 31, 2012, at the Department of Emergency Medicine were included. We analyzed data on baseline characteristics, reason for referral, medication, cardiovascular risk factors, and outcome in terms of presence of AMI along with laboratory data (high-sensitive troponin T, creatinine). A total of 1,514 patients (67% male, aged 65 ± 16 years) were included, of which 382 patients (25%) had moderate to severe renal insufficiency and significantly higher levels of high-sensitive troponin T on admission (0.028 vs 0.009, p <0.0001). In patients without AMI, high-sensitive troponin T correlated inversely with the estimated glomerular filtration rate (R = -0.12, p <0.0001). Overall, sensitivity of an elevated high-sensitive troponin for diagnosis of AMI was 0.64 (0.56 to 0.71) and the specificity was 0.48 (0.45 to 0.51). The area under the curve of the receiver operating characteristic for all patients was 0.613 (standard error [SE] 0.023), whereas it was 0.741 (SE 0.029) for patients with a Modification of Diet in Renal Disease estimated glomerular filtration rate >60 ml/min presenting with acute chest pain or dyspnea and 0.535 (SE 0.056) for patients with moderate to severe renal insufficiency presenting with acute chest pain or dyspnea. In conclusion, the diagnostic accuracy for presence of AMI of a baseline measurement of high-sensitive troponin in patients with renal insufficiency was poor and resembles tossing a coin.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Pfortmüller, Carmen; Leichtle, Alexander Benedikt; Fiedler, Martin; Exadaktylos, Aristomenis and Lindner, Gregor

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0002-9149

Publisher:

Elsevier

Language:

English

Submitter:

Patricia Rajaonina

Date Deposited:

28 Mar 2014 15:19

Last Modified:

30 Apr 2014 08:12

Publisher DOI:

10.1016/j.amjcard.2013.08.028

PubMed ID:

24091183

URI:

https://boris.unibe.ch/id/eprint/47291

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