Gallacher, PJ;
Miller-Hodges, E;
Shah, ASV;
Farrah, TE;
Halbesma, N;
Blackmur, JP;
Chapman, AR;
Adamson, PD;
Anand, A;
Strachan, FE;
et al.
Gallacher, PJ; Miller-Hodges, E; Shah, ASV; Farrah, TE; Halbesma, N; Blackmur, JP; Chapman, AR; Adamson, PD; Anand, A; Strachan, FE; Ferry, AV; Lee, KK; Berry, C; Findlay, I; Cruickshank, A; Reid, A; Gray, A; Collinson, PO; Apple, FS; McAllister, DA; Maguire, D; Fox, KAA; Keerie, C; Weir, CJ; Newby, DE; Mills, NL; Dhaun, N; High-STEACS Investigators
(2000)
High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment.
Kidney Int, 102 (1).
pp. 149-159.
ISSN 1523-1755
https://doi.org/10.1016/j.kint.2022.02.019
SGUL Authors: Collinson, Paul
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Abstract
The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in the diagnosis of myocardial infarction in patients with kidney impairment is unclear. Here, we describe implementation of hs-cTnI testing on the diagnosis, management, and outcomes of myocardial infarction in patients with and without kidney impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized controlled trial were included in this pre-specified secondary analysis. Kidney impairment was defined as an eGFR under 60mL/min/1.73m2. The index diagnosis and primary outcome of type 1 and type 4b myocardial infarction or cardiovascular death at one year were compared in patients with and without kidney impairment following implementation of hs-cTnI assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 patients (mean age 61 years; 47% women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th centile in 46% and 16% of patients with and without kidney impairment. Implementation increased the diagnosis of type 1 infarction from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without kidney impairment (both significant). Patients with kidney impairment and type 1 myocardial infarction were less likely to undergo coronary revascularization (26% versus 53%) or receive dual anti-platelets (40% versus 68%) than those without kidney impairment, and this did not change post-implementation. In patients with hs-cTnI above the 99th centile, the primary outcome occurred twice as often in those with kidney impairment compared to those without (24% versus 12%, hazard ratio 1.53, 95% confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without kidney impairment.
Item Type: | Article | ||||||||||||||||||||||||||||||||||||
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Additional Information: | Copyright © 2022, International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). | ||||||||||||||||||||||||||||||||||||
Keywords: | cardiovascular disease, chronic kidney disease, High-STEACS Investigators, 1103 Clinical Sciences, Urology & Nephrology | ||||||||||||||||||||||||||||||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||||||||||||||||||||||||||||||
Journal or Publication Title: | Kidney Int | ||||||||||||||||||||||||||||||||||||
ISSN: | 1523-1755 | ||||||||||||||||||||||||||||||||||||
Language: | eng | ||||||||||||||||||||||||||||||||||||
Publisher License: | Creative Commons: Attribution 4.0 | ||||||||||||||||||||||||||||||||||||
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PubMed ID: | 35271932 | ||||||||||||||||||||||||||||||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/114307 | ||||||||||||||||||||||||||||||||||||
Publisher's version: | https://doi.org/10.1016/j.kint.2022.02.019 |
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