Key result
Poor renal function did not significantly alter the prevalence of severe CAD stenosis compared to normal renal function in patients with elevated cTnT (87.1% vs 89.7%, p=0.54).
Why the study?
Does poor renal function alter the prevalence of significant coronary artery disease in patients with acute coronary syndrome and elevated troponin T?
Cohort (n=342)
Does poor renal function alter the prevalence of significant coronary artery disease in patients with acute coronary syndrome and elevated troponin T?
Absolute Event Rate: 87.1% vs 89.7%
p-value: p=0.54
Elevated troponin T in the setting of acute coronary syndrome is highly predictive of significant angiographic coronary artery disease, regardless of the patient's baseline renal function.
Elevated cTnT predicts severe CAD stenosis irrespective of renal function; leaves open prospective validation in ACS cohorts.
BACKGROUND: Patients with elevated troponin are at high risk of adverse outcomes, future cardiac events, and are more likely to have hemodynamically significant coronary artery stenoses. Elevated troponin T (cTnT) in patients with poor renal function portends a poor prognosis; however, findings of significant coronary artery disease (CAD) by coronary angiography have not been demonstrated in patients with poor renal function and elevated cTnT. HYPOTHESIS: The purpose of this study was to correlate the angiographic findings of patients with elevated cTnT with respect to renal function in patients with nondialysis-dependent renal insufficiency. METHODS: We retrospectively identified 342 patients with elevated cTnT who underwent coronary angiography in the setting of acute coronary syndrome. Patients were divided into poor (< 40 ml/min) and normal (> 40 ml/min) renal function by measuring their glomerular filtration rate. Our primary outcome was CAD stenosis, defined as epicardial stenosis > or = 70%. Secondary outcomes were rates of contrast nephropathy, initiation of hemodialysis, revascularization, length of stay (LOS), and in-hospital mortality. RESULTS: There was no significant difference in the prevalence of CAD between patients who had positive cTnT with poor renal function versus patients with positive cTnT and normal renal function (87.1 vs. 89.7%, p = 0.54). This finding persisted after stratifying by age. Patients with impaired renal function had a higher mortality, longer LOS, and a higher rate contrast nephropathy requiring hemodialysis. CONCLUSION: The association between elevated cTnT and significant CAD stenosis does not vary with renal function.
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Heitner et al. (2005) conducted a cohort in Acute coronary syndrome with elevated troponin T and nondialysis-dependent renal insufficiency (n=342). Poor renal function (GFR < 40 ml/min) vs. Normal renal function (GFR > 40 ml/min) was evaluated on CAD stenosis (epicardial stenosis ≥ 70%) (p=0.54). Poor renal function did not significantly alter the prevalence of severe CAD stenosis compared to normal renal function in patients with elevated cTnT (87.1% vs 89.7%, p=0.54).
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