Key result
In end-stage renal disease patients with acute coronary syndrome, an initial cardiac troponin T level ≥0.35 ng/mL independently predicted a significantly higher risk of all-cause mortality (HR 8.65) compared to levels ≤0.01 ng/mL.
Why the study?
Does an initial cardiac troponin T level ≥0.35 ng/mL accurately diagnose acute myocardial infarction and predict mortality in ESRD patients with acute coronary syndrome?
Observational (n=284)
No
Does an initial cardiac troponin T level ≥0.35 ng/mL accurately diagnose acute myocardial infarction and predict mortality in ESRD patients with acute coronary syndrome?
Hazard Ratio: 8.65 (95% CI 1.01–74.01)
p-value: p=0.049
In ESRD patients presenting with ACS, a higher cTnT cut-off of 0.35 ng/mL provides optimal diagnostic accuracy for AMI and independently predicts all-cause and cardiovascular mortality.
Should not yet change troponin thresholds in ESRD-ACS; extends observational mortality data but requires prospective validation.
PURPOSE: Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS: AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT ≥0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration ≥0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are ≥0.35 ng/mL.
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Ryu et al. (2011) conducted an observational in End-stage renal disease with acute coronary syndrome (n=284). Initial cardiac troponin T (cTnT) ≥0.35 ng/mL vs. Initial cTnT ≤0.01 ng/mL was evaluated on All-cause mortality (HR 8.65, 95% CI 1.01-74.01, p=0.049). In end-stage renal disease patients with acute coronary syndrome, an initial cardiac troponin T level ≥0.35 ng/mL independently predicted a significantly higher risk of all-cause mortality (HR 8.65) compared to levels ≤0.01 ng/mL.
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