Why the study?
Diagnosing myocardial infarction in patients with CKD is challenging due to baseline elevated troponin levels, and no widely accepted guidelines define a clinically significant troponin change in this population.
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Highlights the diagnostic challenge of interpreting troponin changes in CKD patients presenting with chest pain, where an 11% delta change preceded a major STEMI.
Acute coronary syndrome (ACS) is common in people with chronic kidney disease (CKD) and is linked to poor short- and long-term outcomes. The diagnosis of myocardial infarction is challenging in patients with CKD as they have baseline elevated troponin levels. To date, there are no widely accepted guidelines to suggest what is a clinically significant change in troponin levels in these patients. We report a case of a patient with CKD who presented with chest pain to the emergency department (ED). His baseline troponin was high; however, the delta change was 11%. He was discharged from the ED for outpatient follow-up, but within 36 hours, he had significant ST elevation myocardial infarction (STEMI) with unstable hemodynamics and acute heart failure requiring urgent intubation and coronary revascularization. This case highlights the gap in clinical knowledge and practice in a relatively not uncommon presentation in emergency departments.
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Alseiari et al. (2023) studied this question.
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