Elevated hs-cTnT independently predicted in-hospital mortality in AMI patients with chronic kidney disease (OR 2.82; 95% CI 1.03-9.86; p=0.038), but not in those with normal renal function.
Cohort (n=5,022)
Do peak high-sensitivity cardiac troponin T and CK-MB levels predict in-hospital mortality in patients with acute myocardial infarction and chronic kidney disease?
Peak hs-cTnT and CK-MB levels are independent predictors of in-hospital mortality in patients with acute myocardial infarction and chronic kidney disease, whereas only CK-MB predicts mortality in those with normal renal function.
Odds Ratio: 2.82 (95% CI 1.03–9.86)
p-value: p=0.038
Background: High-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase (CK)-MB are the most commonly used biomarkers for the diagnosis and prognosis of acute myocardial infarction (AMI). Chronic kidney disease (CKD) often leads to elevated hs-cTnT levels in non-AMI patients. However, studies comparing the prognostic value of both hs-cTnT and CK-MB in patients with AMI and CKD are lacking.Methods: We conducted a retrospective study on AMI patients diagnosed between January 2015 and October 2020. Patients were categorized based on renal function as normal or CKD. Peak hs-cTnT and CK-MB levels during hospitalization were collected, and their diagnostic value was evaluated using receiver operating characteristic (ROC) curves. The impact on in-hospital mortality was analyzed using multivariate logistic regression. The relationship between the hs-cTnT/CK-MB ratio and in-hospital death was examined using a restricted cubic spline (RCS) curve.Results: The study included 5022 AMI patients, of whom 797 (15.9%) had CKD. The AUCs of Hs-cTnT and CK-MB were higher in the CKD group 0.842 (95% CI: 0.789–0.894) and 0.821 (95% CI: 0.760–0.882) than in the normal renal function group 0.695 (95% CI: 0.604-0.790) and 0.708 (95% CI: 0.624-0.793). After full adjustment for all risk factors, hs-cTnT (OR, 2.82; 95% CI, 1.03–9.86; p = 0.038) and CK-MB (OR, 4.91; 95% CI, 1.54–14.68; p = 0.007) above the cutoff values were independent predictors of in-hospital mortality in patients with CKD. However, in patients with normal renal function, only CK-MB above the cutoff (OR, 2.45; 95% CI, 1.02–8.24; p = 0.046) was a predictor of in-hospital mortality, whereas hs-cTnT was not. There was an inverted V-shaped relationship between the hs-cTnT/CK-MB ratio and in-hospital mortality, with an inflection point of 19.61. The ratio within the second quartile (9.63-19.6) was an independent predictor of in-hospital mortality in patients with CKD (OR 5.3, 95% CI 1.66–16.86, p = 0.005).Conclusions: Hs-cTnT independently predicted in-hospital mortality in AMI patients with CKD, whereas its predictive value was not observed in patients with normal renal function. CK-MB was an independent predictor of in-hospital mortality regardless of renal function. Moreover, the hs-cTnT/CK-MB ratio may aid in risk stratification of AMI patients with CKD.
Chen et al. (Tue,) conducted a cohort in Acute myocardial infarction and chronic kidney disease (n=5,022). High-sensitivity cardiac troponin T (hs-cTnT) above cutoff vs. hs-cTnT below cutoff was evaluated on In-hospital mortality (OR 2.82, 95% CI 1.03-9.86, p=0.038). Elevated hs-cTnT independently predicted in-hospital mortality in AMI patients with chronic kidney disease (OR 2.82; 95% CI 1.03-9.86; p=0.038), but not in those with normal renal function.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: