Yonsei Med J.  2011 Jul;52(4):595-602. 10.3349/ymj.2011.52.4.595.

A More Appropriate Cardiac Troponin T Level That Can Predict Outcomes in End-Stage Renal Disease Patients with Acute Coronary Syndrome

• Ryu DR
• Park JT
• Chung JH
• Song EM
• Roh SH
• Lee JM
• An HR
• Yu M
• Pyun WB
• Shin GJ
• Kim SJ
• Kang DH
• Choi KB

• KMID: 1727991
• DOI: http://doi.org/10.3349/ymj.2011.52.4.595

Abstract

PURPOSE
Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS).
MATERIALS AND METHODS
Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis.
RESULTS
AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality.
CONCLUSION
Because ESRD patients with an initial cTnT concentration > or =0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are > or =0.35 ng/mL.

Keyword

Acute coronary syndrome; cardiac troponin T; end-stage renal disease

MeSH Terms

Acute Coronary Syndrome/blood/complications/*diagnosis/mortality
Aged
Biological Markers/blood
Female
Humans
Kidney Failure, Chronic/blood/complications/*diagnosis/mortality
Male
Middle Aged
Prognosis
Retrospective Studies
Sensitivity and Specificity
Troponin T/*blood

Figure

• 

  Fig. 1 Receiver operator characteristic (ROC) curve of cardiac troponin T (cTnT) for diagnosing acute myocardial infarction. The area under the curve (AUC) was 0.98 (p<0.001; 95% CI, 0.95-1.00). The cTnT value of 0.35 ng/mL offers the best overall sensitivity and specificity; the sensitivity was 0.95 and the specificity was 0.97.

• 

  Fig. 2 Kaplan-Meier survival curves according to initial cardiac troponin T (cTnT) levels. (A) The all-cause mortality rate in the group with initial cTnT ≥0.35 ng/mL is significantly higher compared to the other groups by log-rank test (p<0.001). (B) The cardiovascular mortality rate in the group with initial cTnT ≥0.35 ng/mL is also significantly higher than in the other groups (p<0.001).

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