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Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T

  • Hualan Huang , Shuai Zhu , Weiqing Wang , Hong Yi , Xiangyang Du , Xin Nie , Yong He , Haolan Song , Qiang Miao , Lanlan Wang EMAIL logo and Guixing Li EMAIL logo
Published/Copyright: January 13, 2015
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue 5

Abstract

Background: The objective of this study was to examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for acute myocardial infarction (AMI) in patients with renal insufficiency, since this population has a high incidence of non-AMI elevations of hs-cTnT.

Methods: In this prospective study, we enrolled 2249 consecutive patients presenting with chest pain in the emergency department (ED), of whom 19.5% had an estimated glomerular filtration rate (eGFR)cys of <60 mL·min–1 (1.73 m2)–1. Hs-cTnT levels were measured blindly at presentation.

Results: Of the patients, 1108 (49.3%) were diagnosed as having AMI [321 with non-ST segment elevation myocardial infarction (NSTEMI)]. In patients whose final diagnosis was not AMI, there was a low but significant correlation between hs-cTnT and renal function [eGFRcys, r=–0.43 (–0.48, –0.38), p<0.001; eGFRcreat, r=–0.33 (–0.38, –0.27), p<0.001]. The area under the curve of the receiver operating characteristic (AUC) for hs-cTnT to diagnose AMI was 0.93 in patients with eGFRcys levels of <30 mL·min–1 (1.73 m2)–1, and AUCs did not vary significantly according to eGFR categories. On the basis of the ROC curve, the optimal threshold value for hs-cTnT was 143.6 ng·L–1 to diagnose AMI in patients with eGFRcys of <30 mL·min–1 (1.73 m2)–1, with a sensitivity of 83% and a specificity of 91%; 54.1 ng·L–1 in patients with eGFRcys between 30 and 59 mL·min–1, with a sensitivity of 90% and a specificity of 87%; 30.0 ng·L–1 in patients with eGFRcys between 60 and 89 mL·min–1, with a sensitivity of 89% and a specificity of 85%; and 20.3 ng·L–1 in patients with eGFRcys ≥90 mL·min–1 (1.73 m2)–1, with a sensitivity of 92% and a specificity of 88%. The same observations were done for the diagnosis of NSTEMI.

Conclusions: Using a higher hs-cTnT cut-off value based on eGFR level is necessary for accurate diagnosis of AMI or NSTEMI in patients with renal insufficiency.

Keywords: acute myocardial infarction (AMI); estimated glomerular filtration rate (eGFR); high-sensitivity cardiac troponin T (hs-cTnT)
Corresponding authors: Guixing Li, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R. China, Phone/Fax: +86 028 85422615, E-mail: ; and Lanlan Wang, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R. China, Phone/Fax: +86 028 85422752, E-mail:

Acknowledgments

We gratefully acknowledge the participation of members of the emergency department of West China Hospital in this study.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Financial support: This study was supported by Roche Diagnostics GmbH in Shanghai (H1311115).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2014-7-12
Accepted: 2014-11-27
Published Online: 2015-1-13
Published in Print: 2015-4-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. High-sensitivity assays for cardiac troponins
  4. Reviews
  5. High sensitivity cardiac troponin assays in the clinical laboratories
  6. Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm
  7. Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction
  8. Cardiovascular Diseases
  9. Evaluation of standardization capability of current cardiac troponin I assays by a correlation study: results of an IFCC pilot project
  10. Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly
  11. High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study
  12. Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction
  13. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
  14. Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T
  15. General Clinical Chemistry and Laboratory Medicine
  16. Active intervention in hospital test request panels pays
  17. An approach to establish the uncertainty budget of catalytic activity concentration measurements in a reference laboratory
  18. Uric acid: a potential biomarker of multiple sclerosis and of its disability
  19. Experience with the first fully automated chemiluminescence immunoassay for the quantification of 1α, 25-dihydroxy-vitamin D
  20. I-FABP and L-FABP are early markers for abdominal injury with limited prognostic value for secondary organ failures in the post-traumatic course
  21. Quantification of piperacillin, tazobactam, cefepime, meropenem, ciprofloxacin and linezolid in serum using an isotope dilution UHPLC-MS/MS method with semi-automated sample preparation
  22. Plasma visfatin/nicotinamide phosphoribosyltransferase (visfatin/NAMPT) concentration is not related to kidney function in elderly subjects
  23. Diagnostic performance study of an antigen microarray for the detection of antiphospholipid antibodies in human serum
  24. Dry ice exposure of plasma samples influences pH and lupus anticoagulant analysis
  25. Reference Values and Biological Variations
  26. A new robust statistical model for interpretation of differences in serial test results from an individual
  27. Cancer Diagnostics
  28. The value of red blood cell distribution width in endometrial cancer
  29. Letters to the Editors
  30. Serum high-sensitivity troponin concentrations in a multi-ethnic Asian population of stable chronic kidney disease patients
  31. Comparison between BNP values measured in capillary blood samples with a POCT method and those measured in plasma venous samples with an automated platform
  32. Reply to the article entitled “Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D” by Farrell et al., Clin Chem Lab Med 2014;52:1579–87
  33. Reply. Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D. Authors’ response to the Letter to the Editor by Donnelly et al.
  34. Therapeutic drug monitoring of voriconazole: validation of a novel ARK™ immunoassay and comparison with ultra-high performance liquid chromatography
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https://doi.org/10.1515/cclm-2014-0715
Keywords for this article
acute myocardial infarction (AMI); estimated glomerular filtration rate (eGFR); high-sensitivity cardiac troponin T (hs-cTnT)

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. High-sensitivity assays for cardiac troponins
  4. Reviews
  5. High sensitivity cardiac troponin assays in the clinical laboratories
  6. Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm
  7. Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction
  8. Cardiovascular Diseases
  9. Evaluation of standardization capability of current cardiac troponin I assays by a correlation study: results of an IFCC pilot project
  10. Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly
  11. High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study
  12. Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction
  13. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
  14. Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T
  15. General Clinical Chemistry and Laboratory Medicine
  16. Active intervention in hospital test request panels pays
  17. An approach to establish the uncertainty budget of catalytic activity concentration measurements in a reference laboratory
  18. Uric acid: a potential biomarker of multiple sclerosis and of its disability
  19. Experience with the first fully automated chemiluminescence immunoassay for the quantification of 1α, 25-dihydroxy-vitamin D
  20. I-FABP and L-FABP are early markers for abdominal injury with limited prognostic value for secondary organ failures in the post-traumatic course
  21. Quantification of piperacillin, tazobactam, cefepime, meropenem, ciprofloxacin and linezolid in serum using an isotope dilution UHPLC-MS/MS method with semi-automated sample preparation
  22. Plasma visfatin/nicotinamide phosphoribosyltransferase (visfatin/NAMPT) concentration is not related to kidney function in elderly subjects
  23. Diagnostic performance study of an antigen microarray for the detection of antiphospholipid antibodies in human serum
  24. Dry ice exposure of plasma samples influences pH and lupus anticoagulant analysis
  25. Reference Values and Biological Variations
  26. A new robust statistical model for interpretation of differences in serial test results from an individual
  27. Cancer Diagnostics
  28. The value of red blood cell distribution width in endometrial cancer
  29. Letters to the Editors
  30. Serum high-sensitivity troponin concentrations in a multi-ethnic Asian population of stable chronic kidney disease patients
  31. Comparison between BNP values measured in capillary blood samples with a POCT method and those measured in plasma venous samples with an automated platform
  32. Reply to the article entitled “Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D” by Farrell et al., Clin Chem Lab Med 2014;52:1579–87
  33. Reply. Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D. Authors’ response to the Letter to the Editor by Donnelly et al.
  34. Therapeutic drug monitoring of voriconazole: validation of a novel ARK™ immunoassay and comparison with ultra-high performance liquid chromatography
  35. Interference of C-reactive protein with clotting times
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