Ideal high sensitivity troponin baseline cutoff for patients with renal dysfunction - 29/07/21
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Abstract |
Objective |
High-sensitivity cardiac troponin assays (hs-cTn) aid in diagnosis of myocardial infarction (MI). These assays have lower specificity for non-ST Elevation MI (NSTEMI) in patients with renal disease. Our objective was to determine an optimized cutoff for patients with renal disease.
Methods |
We conducted an a priori secondary analysis of a prospective FDA study in adults with suspected MI presenting to 29 academic urban EDs between 4/2015 and 4/2016. Blood was drawn 0, 1, 2–3, and 6–9 h after ED arrival. We recorded cTn and estimated glomerular filtrate rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration equation. The primary endpoint was NSTEMI (Third Universal Definition of MI), adjudicated by physicians blinded to hs-cTn results. We generated an adjusted hscTn rule-in cutoff to increase specificity.
Results |
2505 subjects were enrolled; 234 were excluded. Patients were mostly male (55.7%) and white (57.2%), median age was 56 years 472 patients [20.8%] had an eGFR <60 mL/min/1.73 m2. In patients with eGFR <15 mL/min/1.73 m2, a baseline rule-in cutoff of 120 ng/L led to a specificity of 85.0% and Positive Predictive Value (PPV) of 62.5% with 774 patients requiring further observation. Increasing the cutoff to 600 ng/L increased specificity and PPV overall and in every eGFR subgroup (specificity and PPV 93.3% and 78.9%, respectively for eGFR <15 mL/min/1.73m2), while increasing the number (79) of patients requiring observation.
Conclusions |
An eGFR-adjusted baseline rule-in threshold for the Siemens Atellica hs-cTnI improves specificity with identical sensitivity. Further study in a prospective cohort with higher rates of renal disease is warranted.
Le texte complet de cet article est disponible en PDF.Highlights |
• | High sensitivity troponin specificity is lower in patients with renal disease. |
• | Increasing troponin baseline Rule-in cutoff maintains sensitivity. |
• | Increasing baseline cutoff increases specificity and positive predictive value. |
• | Increasing baseline cutoff requires observing more patients. |
Keywords : Acute coronary syndrome, High-sensitivity troponin assays, Renal disease, Acute myocardial infarction
Plan
☆ | An interim analysis of this paper's data has been presented at the 2019 Society of Academic Emergency Medicine Annual Meeting in Las Vegas, NV. Its abstract appeared in the corresponding journal Supplement. |
Vol 46
P. 170-175 - août 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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