Key result
Initial hs-cTnI cutoffs for AMI vary widely across assays in patients with renal impairment.
Why the study?
Initial hs-cTnI measurements are difficult to interpret in patients with renal dysfunction because elevated concentrations can occur without AMI, motivating a comparison of reported optimal cutoffs and diagnostic performance across assay platforms and patient subgroups.
What are the optimal diagnostic cutoffs and performance (sensitivity and specificity) of initial high-sensitivity cardiac troponin I measurements for diagnosing acute myocardial infarction in adults with renal dysfunction?
Systematic Review
What are the optimal diagnostic cutoffs and performance (sensitivity and specificity) of initial high-sensitivity cardiac troponin I measurements for diagnosing acute myocardial infarction in adults with renal dysfunction?
Initial hs-cTnI diagnostic cutoffs for acute myocardial infarction vary widely across assays and renal dysfunction subgroups, indicating that no single threshold can replace serial troponin measurements and clinical assessment in this population.
Higher assay-specific hs-cTnI cutoffs may improve AMI diagnosis in renal dysfunction; extends evidence for tailored thresholds across platforms.
Background and Objectives: Initial high-sensitivity cardiac troponin I (hs-cTnI) measurements can be difficult to interpret in patients with renal dysfunction because elevated concentrations may occur without acute myocardial infarction (AMI). This systematic review compared reported optimal hs-cTnI cutoffs and their diagnostic performance across assay platforms and patient subgroups. Materials and Methods: PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science were searched from inception to 21 August 2026. Studies evaluating initial hs-cTnI measurements in adults with renal dysfunction and reporting diagnostic cutoffs with corresponding sensitivity and specificity for AMI were eligible. Risk of bias was assessed using QUADAS-2. Findings were synthesized narratively because of clinical and methodological heterogeneity; no meta-analysis was performed. Results: Five studies were included. In studies analyzing patients with an estimated glomerular filtration rate below 60 mL/min/1.73 m2 as a single group, optimal cutoffs ranged from 25.9 to 54 ng/L, with sensitivities of 76–88.4% and specificities of 83–90%. One study reported substantially higher cutoffs of 500–2610 ng/L across selected subgroups defined by CKD stage, age, and sex, with sensitivities of 80.4–91.4% and specificities of 92.1–100%. In patients receiving dialysis, cutoffs were 75 ng/L for hemodialysis and 144 ng/L for peritoneal dialysis, yielding sensitivities of 93.3% and 100% and specificities of 60.8% and 83.1%, respectively. All five studies were rated as having a high risk of bias in the index test domain. Conclusions: Reported initial hs-cTnI cutoffs varied considerably across assays and patient populations. The available evidence does not establish a single cutoff applicable to all patients with renal dysfunction. These thresholds require external validation and should be interpreted alongside clinical findings and serial troponin measurements.
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Oh et al. (2026) conducted a systematic review in Renal dysfunction and suspected acute myocardial infarction. Initial high-sensitivity cardiac troponin I (hs-cTnI) measurement was evaluated on Diagnostic performance (optimal cutoffs, sensitivity, and specificity) for acute myocardial infarction. Initial hs-cTnI cutoffs for AMI in eGFR <60 mL/min/1.73 m2 ranged from 25.9 to 54 ng/L (sensitivity 76–88.4%, specificity 83–90%), varying widely across assays and populations.
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