High-Sensitivity Cardiac Troponin and the Diagnosis of Myocardial Infarction in Patients with Renal Impairment

High-STEACS Investigators, Peter J Gallacher, Eve Miller-Hodges, Anoop S.v. Shah, Tariq Farrah, Nynke Halbesma, James P Blackmur, Andrew R Chapman, Philip D Adamson, Atul Anand, Fiona E Strachan, Amy V Ferry, Kuan Ken Lee, Colin Berry, Iain Findlay, Anne Cruickshank, Alan Reid, Alasdair Gray, Paul O Collinson, Fred S AppleDavid A McAllister, Donogh Maguire, Keith AA Fox, Catriona Keerie, Christopher J Weir, David E Newby, Nicholas L Mills, Neeraj Dhaun*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The benefit and utility of high-sensitivity cardiac troponin in the diagnosis of myocardial infarction (MI) in patients with renal impairment is unclear. Here, we describe the implementation of high-sensitivity cardiac troponin testing on the diagnosis, management, and outcomes of MI in patients with and without renal impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomised controlled trial were included in this pre-specified secondary analysis. Renal impairment was defined as an eGFR <60mL/min/1.73m2. The index diagnosis and primary outcome of type 1/4b MI or cardiovascular death at one year were compared in patients with and without renal impairment following implementation of a high-sensitivity cardiac troponin I assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 (97%) patients (61±17years; 47% women), of whom 9,080 (19%) had renal impairment. Cardiac troponins were >99th centile in 46% and 16% of patients with and without renal impairment. Implementation increased the diagnosis of type 1 MI from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without renal impairment (P<0.001 [both]). Patients with renal impairment and type 1 MI were less likely to undergo coronary revascularisation (26% versus 53%; P<0.001) or receive dual anti-platelets (40% versus 68%;P<0.001) than those without renal impairment, and this did not change post-implementation. In patients with cardiac troponins >99th centile, the primary outcome occurred twice as often in those with renal impairment compared to those without (24% versus 12%, HR 1.53, 95%CI 1.31 to 1.78). Implementation increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without renal impairment.
Original languageEnglish
JournalKidney International
DOIs
Publication statusPublished - 7 Mar 2022

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