High sensitive TROponin levels In Patients with Chest pain and kidney disease: a multicenter registry: The TROPIC study

Flavia Ballocca, Fabrizio D'Ascenzo, Claudio Moretti, Roberto Diletti, Carlo Budano, Alberto Palazzuoli, Matthew J. Reed, Tullio Palmerini, Dariusz Dudek, Alfredo Galassi, Pierluigi Omedè, Nicolas M Mieghem, David Ferenbach, Marco Pavani, Diego Della Riva, Nick L. Mills, Ron T Van Domburgh, Andrea Mariani, Artur Dziewierz, Marco di CuiaRobert Jan van Geuns, Felix Zijlstra, Serena Bergerone, Sebastiano Marra, Giuseppe Biondi Zoccai, Fiorenzo Gaita

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Accuracy of high sensitive troponin (hs-cTn) to detect coronary artery disease (CAD) in patients with renal insufficiency is not established. The aim of this study was to evaluate the prognostic role of high sensitivity troponin T and I in patients with chronic kidney disease (CKD).

METHODS: All consecutive patients with chest pain, renal insufficiency (eGFR < 60 mL/min/1.73 m²) and high sensitive troponin level were included. The predictive value of baseline and interval troponin (hs-cTnT and I) for the presence of CAD was assessed.

RESULTS: 113 patients with troponin I and 534 with troponin T were included, with 95 (84%) and 463 (87%) diagnosis of CAD respectively. There were no differences in clinical, procedural and outcomes between the two assays. For both, baseline hs-cTn values did not differ between patients with/without CAD showing low AUCs. For interval levels, hs-cTn I was significantly higher for patients with CAD (0.2 ± 0.8 vs. 8.9 ± 4.6 ng/mL; p = 0.04) and AUC was more accurate for troponin I than hs-cTn T (AUC 0.85 vs. 0.69). Peak level was greater for hs-cTn I in patients with CAD or thrombus (0.4 ± 0.6 vs. 15 ± 20 ng/mL; p = 0.02; AUC 0.87: 0.79-0.93); no differences were found for troponin T assays (0.8 ± 1.5 vs. 2.2 ± 3.6 ng/mL; p = 1.7), with lower AUC (0.73: 0.69-0.77). Peak troponin levels (both T and I) independently predicted all cause death at 30 days.

CONCLUSIONS: Patients with CKD presenting with altered troponin are at high risk of coronary disease. Peak level of both troponin assays predicts events at 30 days, with troponin I being more accurate than troponin T.

Original languageEnglish
JournalCardiology journal
DOIs
Publication statusPublished - 10 Mar 2017

Keywords

  • Journal Article

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