High-Sensitivity Cardiac Troponin T in Patients with Severe Chronic Kidney Disease and Suspected Acute Coronary Syndrome

Figures

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  Figure 1. Flow chart of patient selection process. ACS, acute coronary syndrome; CPR, cardiopulmonary resuscitation; ED, emergency department; eGFR, estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

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  Figure 2. Levels of hs-cTnT at serial sampling. (A) Patients with normal renal function versus patients with severe CKD. (B–D) Among patients with severe CKD: (B) according to revascularization and conservative treatment, (C) in presence or absence of CKD G5D, and (D) in the subgroup of patients undergoing revascularization, in those with versus without CKD G5D. Data are depicted as medians with Q1. p-values are from a generalized linear model accounting for between and within group differences. CKD, chronic kidney disease; CKD G5D, chronic kidney disease G5 treated by dialysis; hs-cTnT, high-sensitivity cardiac troponin T.

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  Figure 3. Diagnostic performance of hs-cTnT at serial sampling in patients with severe CKD. Depicted are ROCs and AUCs with 95% confidence intervals (CI) and predefined levels of sensitivity and specificity, describing the performance of the hs-cTnT assay for the diagnosis of NSTE-ACS requiring revascularization at (A) presentation, (B) 3 h, and (C) peak prior to angiography. (D) Depicts the improvement of the discrimination power of hs-cTnT at presentation when combined with absolute 3 h changes as compared to each of these variables alone. AUC, area under the receiver operating characteristic curve; CKD, chronic kidney disease; hs-cTnT, high-sensitivity cardiac troponin T; ROC, receiver-operating characteristic curve.

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  Figure 4. AUC of hs-cTnT during serial sampling. Depicted are the AUCs with 95% confidence intervals for hs-cTnT during serial sampling at presentation, 3 h, 6 h, and peak prior to coronary angiography in (A) patients with normal renal function and those with severe CKD and (B) among patients with severe CKD, comparing patients with CKD G5D to those with severe CKD but preserved diuresis. AUC, area under the receiver operating characteristic curve; CKD, chronic kidney disease; CKD G5D, chronic kidney disease G5 treated by dialysis.