Key result
Optimal troponin cut-offs for MI increase to ~48 ng/L in renal impairment and higher in dialysis.
Why the study?
Identifying acute myocardial infarction in patients with renal disease is difficult due to atypical presentation and chronically elevated troponin, warranting specific cut-off values.
Do alternative troponin cut-off values improve the diagnosis of acute myocardial infarction in patients with renal impairment?
Meta-Analysis
Do alternative troponin cut-off values improve the diagnosis of acute myocardial infarction in patients with renal impairment?
Higher specific troponin cut-offs (42 ng/L for TnI, 48 ng/L for TnT, and 239 ng/L for TnT in dialysis) are required to accurately diagnose acute myocardial infarction in patients with renal impairment.
Higher troponin cut-offs are warranted for AMI diagnosis in renal impairment; meta-analysis extends diagnostic evidence with pooled thresholds for clinical and validation use.
Identifying acute myocardial infarction in patients with renal disease is notoriously difficult, due to atypical presentation and chronically elevated troponin. The aim of this study was to identify a specific troponin T/troponin I cut-off value for diagnosis of acute myocardial infarction in patients with renal impairment via meta-analysis. Two investigators screened 2590 publications from MEDLINE, Embase, PubMed, Web of Science, and the Cochrane library. Only studies that investigated alternative cut-offs according to renal impairment were included. Fifteen articles fulfilled the inclusion criteria. Six studies were combined for meta-analysis. The manufacturer's upper reference level for troponin T is 14 ng/L. Based on the meta-analyses, cut-off values for troponin in patients with renal impairment with myocardial infarction was 42 ng/L for troponin I and 48 ng/L for troponin T. For patients on dialysis the troponin T cut-off is even higher at 239 ng/L. A troponin I cut-off value for dialysis patients could not be established due to lack of data. The 15 studies analyzed showed considerable diversity in study design, study population, and the definition of myocardial infarction. Further studies are needed to define a reliable troponin cut-off value for patients with kidney disease, especially in dialysis patients, and to allow necessary subanalysis.
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Kampmann et al. (2022) conducted a meta-analysis in Acute Myocardial Infarction in patients with impaired renal function. Troponin T and Troponin I diagnostic cut-off levels vs. Standard manufacturer upper reference limits (e.g., 14 ng/L for cTnT) was evaluated on Optimal diagnostic cut-off values for cardiac troponin in patients with renal impairment and myocardial infarction. In patients with renal impairment, the optimal diagnostic cut-off values for acute myocardial infarction were 42 ng/L for troponin I and 48 ng/L for troponin T, increasing significantly to 239 ng/L for troponin T in patients on dialysis.
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