HDCN Abstract:  ASN Annual Meeting -- San Diego  

Ryu D, Kim S, Kang D, et al.

Clinical Usefulness of Cardiac Troponin T for Diagnosing Acute Myocardial Infarction in Patients with Chronic Kidney Disease.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:401A 2009

AIM: Cardiac troponin T(cTnT), a useful marker for diagnosis of acute myocardial infarction(AMI) in general population, is detected high above the usual cutoff value(0.1 ng/mL) in many CKD patients without evidence of clinically apparent AMI. The aim of this study was to evaluate more appropriate cutoff value of cTnT for diagnosing AMI in patients with CKD.

METHODS: This study included 1,943 cases of 511 CKD patients(MDRD eGFR 60mL/min/1.73 m2) from March 2002 to February 2008. We reviewed demographic, clinical, and laboratory data retrospectively. AMI was diagnosed in patients with typical rise and gradual fall of CK/CK-MB with at least one of the following: ischemic symptoms, development of pathologic Q waves or changes of ST segment on the ECG, or coronary artery intervention. Clinical usefulness of cTnT for diagnosing AMI was evaluated using receiver operator characteristic(ROC) curve.

RESULTS: Among 1,445 cases of 312 CKD patients undergoing chronic dialysis treatment(mean age 63.611.9, M:F 153:159), AMI was diagnosed in 247 cases and area under the curve(AUC) of cTnT for diagnosing AMI was 0.964 in ROC curve(p<0.001; 95% CI, 0.952-0.975). Among 498 cases of 225 predialysis CKD patients (mean age 68.714.1, M:F 76:149, mean serum creatinine 2.82.0 mg/dL), AMI was diagnosed in 23 cases and AUC of cTnT for diagnosing AMI was 0.979 in ROC curve(p<0.001; 95% CI, 0.960-0.998). The summation of sensitivity and specificity was the highest at the 0.5 ng/mL of cTnT in dialysis patients and 0.25 ng/mL in predialysis CKD patients. False positive rates were 74% and 85% at the 0.1 ng/mL of cTnT in dialysis and predialysis patients, respectively.

CONCLUSIONS: Although moderate elevations of cTnT are common in CKD patients without AMI, measurement of cTnT is useful for diagnosing AMI. Moreover, it may be suggested that urgent diagnosis and treatment are necessary especially in dialysis patients with cTnT levels higher than 0.5 ng/mL and in predialysis patients with cTnT levels higher than 0.25 ng/mL, because false positive rate is low in those patients.

© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
Until September of 2010 all ASN abstracts from the 2009 Annual Meeting are available at this link.

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