Key result
In hemodialysis patients with non-STEMI, cardiac troponin I >0.3 ng/ml was not predictive of obstructive coronary artery disease (OR 0.87; 95% CI 0.19-4.0; p=0.8).
Why the study?
Does elevated cardiac troponin I predict significant coronary artery disease in hemodialysis patients presenting with non-STEMI?
Case-Control (n=90)
Does elevated cardiac troponin I predict significant coronary artery disease in hemodialysis patients presenting with non-STEMI?
Cardiac troponin I elevation does not reliably predict hemodynamically significant coronary artery disease in hemodialysis patients presenting with non-STEMI, suggesting a need for high clinical suspicion regardless of biomarker levels.
High suspicion for obstructive CAD warranted in hemodialysis non-STEMI regardless of troponin; hypothesis-generating and leaves open biomarker utility.
OBJECTIVES: Controversy exists regarding utility of cardiac troponin I (cTnI) in predicting significant coronary artery disease (CAD) in hemodialysis (HD) patients with chest pain and no acute ischemia on electrocardiogram (non-ST segment elevation myocardial infarction, non-STEMI). We sought to determine if cTnI elevation predicts significant CAD (>70% stenosis) in these patients. METHODS: Ninety patients with non-STEMI referred for cardiac catheterization were included, divided equally into HD and non-HD groups. RESULTS: Mean age and baseline characteristics were not significantly different between groups, except for left ventricular hypertrophy which was higher in HD patients (56 vs. 27%, p = 0.012). Initial cTnI correlated with obstructive CAD and was stratified into <0.3 and >0.3 ng/ml. By logistic regression, cTnI >0.3 ng/ml was not predictive of CAD in HD patients [odds ratio = 0.87 (95% CI 0.19-4.0), p = 0.8], while non-HD patients had an increased risk of CAD if first cTnI was >0.3 ng/ml [odds ratio = 1.461 (95% CI 1.01-2.11), p = 0.04] as expected. Sensitivity, specificity, negative and positive predictive values of cTnI in predicting obstructive CAD were better in non-HD patients. CONCLUSION: cTnI in these patients had no predictive value for obstructive CAD. This contrasts with the general population, suggesting a higher index of suspicion for high-grade CAD irrespective of cTnI levels in HD patients.
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Badero et al. (2009) conducted a case-control in Hemodialysis patients with chest pain and non-STEMI (n=90). Cardiac troponin I >0.3 ng/ml vs. Cardiac troponin I <0.3 ng/ml was evaluated on Significant coronary artery disease (>70% stenosis) (OR 0.87, 95% CI 0.19-4.0, p=0.8). In hemodialysis patients with non-STEMI, cardiac troponin I >0.3 ng/ml was not predictive of obstructive coronary artery disease (OR 0.87; 95% CI 0.19-4.0; p=0.8).
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