Key result
Elevated troponin I is linked to ~3.4-fold higher odds of significant coronary lesions.
Why the study?
Does sensitive troponin I accurately discriminate the presence of significant coronary lesions (≥70% stenosis) in emergency department patients presenting with chest pain with or without chronic renal failure?
Observational (n=991)
No
Does sensitive troponin I accurately discriminate the presence of significant coronary lesions (≥70% stenosis) in emergency department patients presenting with chest pain with or without chronic renal failure?
In chest pain patients, achieving reasonable specificity (67%) for significant coronary lesions required a sensitive troponin I threshold of 0.605 ng/dL (~15 times the 99th percentile), and specificity dropped markedly in patients with chronic renal failure.
Answers are grounded in this paper and cite their sources.
May warrant caution interpreting troponin in renal failure due to low specificity; leaves open prospective validation for lesion discrimination.
INTRODUCTION: Despite having higher sensitivity as compared to conventional troponins, sensitive troponins have lower specificity, mainly in patients with renal failure. OBJECTIVE: Study aimed at assessing the sensitive troponin I levels in patients with chest pain, and relating them to the existence of significant coronary lesions. METHODS: Retrospective, single-center, observational. This study included 991 patients divided into two groups: with (N = 681) and without (N = 310) significant coronary lesion. For posterior analysis, the patients were divided into two other groups: with (N = 184) and without (N = 807) chronic renal failure. The commercial ADVIA Centaur® TnI-Ultra assay (Siemens Healthcare Diagnostics) was used. The ROC curve analysis was performed to identify the sensitivity and specificity of the best cutoff point of troponin as a discriminator of the probability of significant coronary lesion. The associations were considered significant when p < 0.05. RESULTS: The median age was 63 years, and 52% of the patients were of the male sex. The area under the ROC curve between the troponin levels and significant coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or without renal failure, the areas under the ROC curve were 0.703 (95% CI: 0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff points to discriminate the presence of significant coronary lesion were: in the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%); in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%; specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL (sensitivity, 80.6%; specificity, 42%). CONCLUSION: In patients with chest pain, sensitive troponin I showed a good correlation with significant coronary lesions when its level was greater than 0.605 ng/dL. In patients with chronic renal failure, a significant decrease in specificity was observed in the correlation of troponin levels and severe coronary lesions.
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Soeiro et al. (2017) conducted an observational in Chest pain with suspected unstable angina or non-ST-elevation acute myocardial infarction (n=991). Sensitive troponin I (ADVIA Centaur TnI-Ultra assay) positivity at best cutoff (>0.605 ng/dL) vs. Negative sensitive troponin I (≤0.605 ng/dL) and subgroup comparison with vs. without chronic renal failure (creatinine >1.5 mg/dL) was evaluated on Significant coronary lesion (≥70% stenosis on coronary angiography) (OR 3.39, 95% CI 2.53-4.54, p=<0.0001). Sensitive troponin I >0.605 ng/dL discriminated significant coronary lesions with an AUC of 0.685 (OR 3.39, 95% CI 2.53-4.54, p<0.0001), though specificity dropped to 42% in chronic renal failure.
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