Key result
Elevated baseline cardiac troponin I differentiates between hemodialysis patients with and without severe coronary artery disease with a test accuracy (AUC) of 0.72.
Why the study?
While chronic cardiac troponin I elevation is linked to severe coronary artery disease in asymptomatic ESRD hemodialysis patients, the association is less clear when patients present with an acute troponin rise.
Does baseline elevation of cardiac troponin I predict the severity of angiographic coronary artery disease in hemodialysis patients presenting with acute symptomatic enzyme elevation?
Observational (n=364)
No
Does baseline elevation of cardiac troponin I predict the severity of angiographic coronary artery disease in hemodialysis patients presenting with acute symptomatic enzyme elevation?
In hemodialysis patients presenting with acute symptoms and elevated troponin, a chronically elevated baseline troponin I strongly predicts the presence of severe obstructive coronary artery disease.
Baseline troponin I may aid CAD differentiation in symptomatic hemodialysis patients; hypothesis-generating and requires prospective validation before practice change.
Background Chronic elevation of cardiac troponin I (cTn-I) has been associated with severe angiographic coronary artery disease (CAD) in asymptomatic patients with end-stage renal disease (ESRD) on hemodialysis. However, for patients presenting with an acute rise in serum cTn-I levels, the association is less clear. Methods We performed a single-center retrospective analysis of 364 hemodialysis patients. Using coronary angiography, we correlated the asymptomatic baseline elevation of cTn-I with the severity of coronary artery stenosis when hemodialysis patients present with acute symptomatic elevation in serum cTn-I above baseline levels. Results In hemodialysis patients presenting with a rise in serum cTn-I above baseline levels, 59% had severe CAD, and 17% had no angiographic evidence of CAD. Hemodialysis patients with severe CAD had significantly higher baseline cTn-I levels compared to patients with non-severe CAD or normal coronaries (p < 0.0001). Baseline elevation of cTn-I in the severe CAD group was correlated with the degree of CAD occlusion (R 2 of 0.56, p < 0.0001), fitting a positive linear model. Furthermore, baseline cTn-I differentiates between patients with and without severe CAD with a test accuracy of 0.72 (95% CI, 0.69–0.75, p < 0.001). At a value of ≥ 0.2 ng/mL (cutoff value for myocardial necrosis), the specificity of baseline cTn-I for underlying severe CAD was 0.95. Conclusions Elevated baseline cTn-I has good accuracy for anticipating more advanced angiographic CAD when hemodialysis patients present with a symptomatic rise in serum cTn-I above baseline levels. Baseline elevation of cTn-I can be used for cardiac disease risk management in hemodialysis patients presenting with symptoms suggestive of CAD.
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Taha et al. (2021) conducted an observational in End-stage renal disease on hemodialysis with suspected acute coronary syndrome (n=364). Elevated baseline cardiac troponin I (cTn-I) vs. Normal or lower baseline cTn-I was evaluated on Accuracy of baseline cTn-I to differentiate between patients with and without severe coronary artery disease (AUC 0.72, 95% CI 0.69-0.75, p=<0.001). Elevated baseline cardiac troponin I differentiates between hemodialysis patients with and without severe coronary artery disease with a test accuracy (AUC) of 0.72.
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