Kraus, Daniel, von Jeinsen, Beatrice, Tzikas, Stergios ORCID: 0000-0002-7811-5620, Palapies, Lars, Zeller, Tanja, Bickel, Christoph, Fette, Georg, Lackner, Karl J., Drechsler, Christiane, Neumann, Johannes T., Baldus, Stephan, Blankenberg, Stefan, Muenzel, Thomas, Wanner, Christoph, Zeiher, Andreas M. and Keller, Till ORCID: 0000-0002-0895-6491 (2018). Cardiac Troponins for the Diagnosis of Acute Myocardial Infarction in Chronic Kidney Disease. J. Am. Heart Assoc., 7 (19). HOBOKEN: WILEY. ISSN 2047-9980

Full text not available from this repository.

Abstract

Background-Patients with chronic kidney disease (CKD) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction (AMI) without ST-segment elevation (NSTE). In patients with CKD, troponin levels are often chronically elevated, which reduces their diagnostic utility when NSTE-AMI is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with CKD and suspected NSTE-AMI. Methods and Results-Two cohorts, 1494 patients from a prospective cohort study with high-sensitivity troponin I (hs-cTnI) measurements and 7059 cases from a clinical registry with high-sensitivity troponin T (hs-cTnT) measurements, were analyzed. The prospective cohort comprised 280 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m(2)). The registry data set contained 1581 CKD patients. In both cohorts, CKD patients were more likely to have adjudicated NSTE-AMI than non-CKD patients. The specificities of hs-cTnI and hs-cTnT to detect NSTE-AMI were reduced with CKD (0.82 versus 0.91 for hs-cTnI and 0.26 versus 0.73 for hs-cTnT) but could be restored by applying optimized cutoffs to either the first or a second measurement after 3 hours. The best diagnostic performance was achieved with an algorithm that incorporates serial measurements and rules in or out AMI in 69% (hs-cTnI) and 55% (hs-cTnT) of CKD patients. Conclusions-The diagnostic performance of high-sensitivity cardiac troponins in patients with CKD with suspected NSTE-AMI is improved by use of an algorithm based on admission troponin and dynamic changes in troponin concentration.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kraus, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Jeinsen, BeatriceUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tzikas, StergiosUNSPECIFIEDorcid.org/0000-0002-7811-5620UNSPECIFIED
Palapies, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeller, TanjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bickel, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fette, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lackner, Karl J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Drechsler, ChristianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neumann, Johannes T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Blankenberg, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muenzel, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wanner, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeiher, Andreas M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Keller, TillUNSPECIFIEDorcid.org/0000-0002-0895-6491UNSPECIFIED
URN: urn:nbn:de:hbz:38-169648
DOI: 10.1161/JAHA.117.008032
Journal or Publication Title: J. Am. Heart Assoc.
Volume: 7
Number: 19
Date: 2018
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 2047-9980
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE CORONARY SYNDROMES; I ASSAY; RENAL-FUNCTION; PREDICTION; ACCURACYMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/16964

Downloads

Downloads per month over past year

Altmetric

Export

Actions (login required)

View Item View Item