SP308
INTRA-INDIVIDUAL CHANGES IN HIGH-SENSITIVE TROPONIN I AND T LEVELS IMPROVE DIAGNOSTIC PERFORMANCE FOR ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

INTRODUCTION AND AIMS: High-sensitive cardiac troponin I and T (hs-cTnI, hs-cTnT) are the gold standard to diagnose acute myocardial infarction without persistent ST-segment elevation (NSTE-AMI). Troponins are often non-specifically elevated in chronic kidney disease (CKD), reducing the utility of conventional cut-offs for the diagnosis of NSTE-AMI. The aim of the present study was to develop an algorithm that uses changes in serial troponin measurements to reliably diagnose NSTE-AMI in patients with CKD.

METHODS: A prospective study dataset with 1494 patients and hs-cTnI measurements and a clinical registry dataset with 4478 patients and hs-cTnT measurements were analyzed. All patients presented with suspected AMI to medical emergency departments. Troponin levels were serially measured at baseline and after 3 hours.

RESULTS: In the study dataset, 280 patients had CKD with estimated glomerular filtration rate of less than 60 ml/min/1.73 m²; 73 of these (26%) had NSTE-AMI. The clinical dataset contained 1085 CKD patients, of which 280 (26%) had NSTE-AMI. NSTE-AMI was more prevalent among CKD patients than non-CKD patients. hs-cTnI and hs-cTnT had lower specificities to detect NSTE-AMI when CKD was present (0.82 vs. 0.91 for hs-cTnI and 0.25 vs. 0.75 for hs-cTnT). Applying optimized cut-offs to the first or the second troponin measurement restored specificity at the cost of decreased sensitivity. Incorporating changes in serial measurements into a diagnostic algorithm yielded best diagnostic performance and allowed ruling NSTE-AMI in or out in 65.2% (hs-cTnI) and 58.6% (hs-cTnT) of CKD patients.

CONCLUSIONS: NSTE-AMI can be ruled in or out in the majority of CKD patients with our new diagnostic algorithm that uses changes in serially measured troponin levels.