Gallacher, P. J. et al. (2022) High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with renal impairment. Kidney International, 102(1), pp. 149-159. (doi: 10.1016/j.kint.2022.02.019) (PMID:35271932)
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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/1.73m . 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 61years; 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 revascularisation (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: | Articles |
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| Additional Information: | This trial was funded by a Special Project Grant from the British Heart Foundation (BHF) (SP/12/10/29922) with additional support from a BHF-Turing Cardiovascular Data Science Award (BCDSA/100003) and BHF Research Excellence Award (RE/18/5/34216; RE/18/6/34217). PJG is supported by the Mason Medical Research Foundation and a BHF Clinical Research Training Fellowship (FS/CRTF/20/24079). ARC, NLM and DEN are supported by Clinical Research Training Fellowship (FS/16/75/32533), Butler Senior Clinical Research Fellowship (FS/16/14/32023) and Chair (CH/09/002) awards from the BHF. TEF is supported by an MRC Clinical Research Training Fellowship (MR/R017840/1). NH is supported by a BHF Intermediate Basic Science Research Fellowship (FS/16/36/32205). PDA is supported by a National Heart Foundation of New Zealand Senior Fellowship (1844). CJW was supported by NHS Lothian through the Edinburgh Clinical Trials Unit. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Maguire, Donogh and McAllister, Professor David and Berry, Professor Colin and Newby, Professor David and Findlay, Dr Iain and Cruickshank, Dr Anne |
| Authors: | Gallacher, P. J., Miller-Hodges, E., Shah, A. S.V., Farrah, T. E., Halbesma, N., Blackmur, J. P., Chapman, A. R., Adamson, P. D., Anand, A., Strachan, F. E., Ferry, A. V., Lee, K. K., Berry, C., Findlay, I., Cruickshank, A., Reid, A., Gray, A., Collinson, P. O., Apple, F. S., McAllister, D. A., Maguire, D., Fox, K. A.A., Keerie, C., Weir, C. J., Newby, D. E., Mills, N. L., and Dhaun, N. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Kidney International |
| Publisher: | Elsevier |
| ISSN: | 0085-2538 |
| ISSN (Online): | 1523-1755 |
| Published Online: | 07 March 2022 |
| Copyright Holders: | Copyright © 2022 International Society of Nephrology |
| First Published: | First published in Kidney International 102(1): 149-159 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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