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Optimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction

BACKGROUND—: It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. METHODS AND RESULTS—: In this multicenter... Full description

Journal Title: Circulation 2015, Vol.131(23), pp.2041-2050
Main Author: Twerenbold, Rubini, Raphael
Other Authors: Wildi, Rubini, Karin , Jaeger, Rubini, Cedric , Gimenez, Rubini, Maria , Reiter, Rubini, Miriam , Reichlin, Rubini, Tobias , Walukiewicz, Rubini, Astrid , Gugala, Rubini, Mathias , Krivoshei, Rubini, Lian , Marti, Rubini, Nadine , Moreno Weidmann, Rubini, Zoraida , Hillinger, Rubini, Petra , Puelacher, Rubini, Christian , Rentsch, Rubini, Katharina , Honegger, Rubini, Ursina , Schumacher, Rubini, Carmela , Zurbriggen, Rubini, Felicitas , Freese, Rubini, Michael , Stelzig, Rubini, Claudia , Campodarve, Rubini, Isabel , Bassetti, Rubini, Stefano , Osswald, Rubini, Stefan , Mueller, Rubini, Christian
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ID: ISSN: 0009-7322 ; DOI: 10.1161/CIRCULATIONAHA.114.014245
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recordid: ovid10.1161/CIRCULATIONAHA.114.014245
title: Optimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction
format: Article
creator:
  • Twerenbold, Rubini, Raphael
  • Wildi, Rubini, Karin
  • Jaeger, Rubini, Cedric
  • Gimenez, Rubini, Maria
  • Reiter, Rubini, Miriam
  • Reichlin, Rubini, Tobias
  • Walukiewicz, Rubini, Astrid
  • Gugala, Rubini, Mathias
  • Krivoshei, Rubini, Lian
  • Marti, Rubini, Nadine
  • Moreno Weidmann, Rubini, Zoraida
  • Hillinger, Rubini, Petra
  • Puelacher, Rubini, Christian
  • Rentsch, Rubini, Katharina
  • Honegger, Rubini, Ursina
  • Schumacher, Rubini, Carmela
  • Zurbriggen, Rubini, Felicitas
  • Freese, Rubini, Michael
  • Stelzig, Rubini, Claudia
  • Campodarve, Rubini, Isabel
  • Bassetti, Rubini, Stefano
  • Osswald, Rubini, Stefan
  • Mueller, Rubini, Christian
subjects:
  • Medicine
  • Anatomy & Physiology
ispartof: Circulation, 2015, Vol.131(23), pp.2041-2050
description: BACKGROUND—: It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. METHODS AND RESULTS—: In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease–estimated glomerular filtration rate
language:
source:
identifier: ISSN: 0009-7322 ; DOI: 10.1161/CIRCULATIONAHA.114.014245
fulltext: fulltext
issn:
  • 0009-7322
  • 00097322
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titleOptimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction
creatorTwerenbold, Rubini, Raphael ; Wildi, Rubini, Karin ; Jaeger, Rubini, Cedric ; Gimenez, Rubini, Maria ; Reiter, Rubini, Miriam ; Reichlin, Rubini, Tobias ; Walukiewicz, Rubini, Astrid ; Gugala, Rubini, Mathias ; Krivoshei, Rubini, Lian ; Marti, Rubini, Nadine ; Moreno Weidmann, Rubini, Zoraida ; Hillinger, Rubini, Petra ; Puelacher, Rubini, Christian ; Rentsch, Rubini, Katharina ; Honegger, Rubini, Ursina ; Schumacher, Rubini, Carmela ; Zurbriggen, Rubini, Felicitas ; Freese, Rubini, Michael ; Stelzig, Rubini, Claudia ; Campodarve, Rubini, Isabel ; Bassetti, Rubini, Stefano ; Osswald, Rubini, Stefan ; Mueller, Rubini, Christian
ispartofCirculation, 2015, Vol.131(23), pp.2041-2050
identifierISSN: 0009-7322 ; DOI: 10.1161/CIRCULATIONAHA.114.014245
descriptionBACKGROUND—: It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. METHODS AND RESULTS—: In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease–estimated glomerular filtration rate <60 mL·min·1.73 m). The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography and serial levels of high-sensitivity cTnT. Acute myocardial infarction was the final diagnosis in 36% of all patients with renal dysfunction. Among patients with renal dysfunction and elevated baseline cTn levels (≥99th percentile), acute myocardial infarction was the most common diagnosis for all assays (range, 45%–80%). In patients with renal dysfunction, diagnostic accuracy at presentation, quantified by the area under the receiver-operator characteristic curve, was 0.87 to 0.89 with no significant differences between the 7 more sensitive cTn assays and further increased to 0.91 to 0.95 at 3 hours. Overall, the area under the receiver-operator characteristic curve in patients with renal dysfunction was only slightly lower than in patients with normal renal function. The optimal receiver-operator characteristic curve–derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9–3.4). CONCLUSIONS—: More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. CLINICAL TRIAL REGISTRATION—: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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1Wildi, Rubini, Karin
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3Gimenez, Rubini, Maria
4Reiter, Rubini, Miriam
5Reichlin, Rubini, Tobias
6Walukiewicz, Rubini, Astrid
7Gugala, Rubini, Mathias
8Krivoshei, Rubini, Lian
9Marti, Rubini, Nadine
10Moreno Weidmann, Rubini, Zoraida
11Hillinger, Rubini, Petra
12Puelacher, Rubini, Christian
13Rentsch, Rubini, Katharina
14Honegger, Rubini, Ursina
15Schumacher, Rubini, Carmela
16Zurbriggen, Rubini, Felicitas
17Freese, Rubini, Michael
18Stelzig, Rubini, Claudia
19Campodarve, Rubini, Isabel
20Bassetti, Rubini, Stefano
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22Mueller, Rubini, Christian
titleOptimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction
descriptionBACKGROUND—: It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. METHODS AND RESULTS—: In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease–estimated glomerular filtration rate <60 mL·min·1.73 m). The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography and serial levels of high-sensitivity cTnT. Acute myocardial infarction was the final diagnosis in 36% of all patients with renal dysfunction. Among patients with renal dysfunction and elevated baseline cTn levels (≥99th percentile), acute myocardial infarction was the most common diagnosis for all assays (range, 45%–80%). In patients with renal dysfunction, diagnostic accuracy at presentation, quantified by the area under the receiver-operator characteristic curve, was 0.87 to 0.89 with no significant differences between the 7 more sensitive cTn assays and further increased to 0.91 to 0.95 at 3 hours. Overall, the area under the receiver-operator characteristic curve in patients with renal dysfunction was only slightly lower than in patients with normal renal function. The optimal receiver-operator characteristic curve–derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9–3.4). CONCLUSIONS—: More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. CLINICAL TRIAL REGISTRATION—: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
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010.1161/CIRCULATIONAHA.114.014245
1© 2015 by the American College of Cardiology Foundation and the American Heart Association, Inc.
2Lippincott Williams & Wilkins - Journals
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titleOptimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction
authorTwerenbold, Rubini, Raphael ; Wildi, Rubini, Karin ; Jaeger, Rubini, Cedric ; Gimenez, Rubini, Maria ; Reiter, Rubini, Miriam ; Reichlin, Rubini, Tobias ; Walukiewicz, Rubini, Astrid ; Gugala, Rubini, Mathias ; Krivoshei, Rubini, Lian ; Marti, Rubini, Nadine ; Moreno Weidmann, Rubini, Zoraida ; Hillinger, Rubini, Petra ; Puelacher, Rubini, Christian ; Rentsch, Rubini, Katharina ; Honegger, Rubini, Ursina ; Schumacher, Rubini, Carmela ; Zurbriggen, Rubini, Felicitas ; Freese, Rubini, Michael ; Stelzig, Rubini, Claudia ; Campodarve, Rubini, Isabel ; Bassetti, Rubini, Stefano ; Osswald, Rubini, Stefan ; Mueller, Rubini, Christian
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8Krivoshei, Rubini, Lian
9Marti, Rubini, Nadine
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17Freese, Rubini, Michael
18Stelzig, Rubini, Claudia
19Campodarve, Rubini, Isabel
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10Moreno Weidmann, Rubini, Zoraida
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atitleOptimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction
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abstractBACKGROUND—: It is unknown whether more sensitive cardiac troponin (cTn) assays maintain their clinical utility in patients with renal dysfunction. Moreover, their optimal cutoff levels in this vulnerable patient population have not previously been defined. METHODS AND RESULTS—: In this multicenter study, we examined the clinical utility of 7 more sensitive cTn assays (3 sensitive and 4 high-sensitivity cTn assays) in patients presenting with symptoms suggestive of acute myocardial infarction. Among 2813 unselected patients, 447 (16%) had renal dysfunction (defined as Modification of Diet in Renal Disease–estimated glomerular filtration rate <60 mL·min·1.73 m). The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including coronary angiography and serial levels of high-sensitivity cTnT. Acute myocardial infarction was the final diagnosis in 36% of all patients with renal dysfunction. Among patients with renal dysfunction and elevated baseline cTn levels (≥99th percentile), acute myocardial infarction was the most common diagnosis for all assays (range, 45%–80%). In patients with renal dysfunction, diagnostic accuracy at presentation, quantified by the area under the receiver-operator characteristic curve, was 0.87 to 0.89 with no significant differences between the 7 more sensitive cTn assays and further increased to 0.91 to 0.95 at 3 hours. Overall, the area under the receiver-operator characteristic curve in patients with renal dysfunction was only slightly lower than in patients with normal renal function. The optimal receiver-operator characteristic curve–derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9–3.4). CONCLUSIONS—: More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. CLINICAL TRIAL REGISTRATION—: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
pub© 2015 by the American College of Cardiology Foundation and the American Heart Association, Inc.
doi10.1161/CIRCULATIONAHA.114.014245
eissn15244539
date2015-06