Kidney function–specific cut-off values of high-sensitivity cardiac troponin T for the diagnosis of acute myocardial infarction

作者：Ruixuan Chen, Mingzhen Pang, Hongxue Yu, Fan Luo, Xiaodong Zhang, Licong Su, Yanqin Li, Shiyu Zhou, Ruqi Xu, Qi Gao, Daojing Gan, Xin Xu, Sheng Nie, Fan Fan Hou, for the CRDS study Investigators, Hongxia Xu, Bi‐Cheng Liu, Jianping Weng, Chunbo Chen, Jialu Liu, Qiongqiong Yang, Hua Li, Guisen Li, Qijun Wan, Yan Zha, Ying Hu, Gang Xu, Yongjun Shi, Yilun Zhou, Ying Tang, Mengchun Gong, Chen Wang, Dehui Liu, Pengli Luo, Jie Shen, Yi-Hua Bai · 发表于：Clinical Kidney Journal · 年份：2024 · DOI：10.1093/ckj/sfae247 · 被引用次数：10 · 研究领域：Acute Myocardial Infarction Research、Cardiac Imaging and Diagnostics、Venous Thromboembolism Diagnosis and Management

ABSTRACT Background The diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin T (hs-cTnT) remains challenging in patients with kidney dysfunction. Methods In this large, multicenter cohort study, a total of 20 912 adults who underwent coronary angiography were included. Kidney function–specific cut-off values of hs-cTnT were determined to improve the specificity without sacrificing sensitivity, as compared with that using traditional cut-off value (14 ng/L) in the normal kidney function group. The diagnostic accuracy of the novel cut-off values was validated in an independent validation cohort. Results In the derivation cohort (n = 12 900), 3247 patients had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Even in the absence of AMI, 50.2% of participants with eGFR <60 mL/min/1.73 m2 had a hs-cTnT concentration ≥14 ng/L. Using 14 ng/L as the threshold of hs-cTnT for diagnosing AMI led to a significantly reduced specificity and positive predictive value in patients with kidney dysfunction, as compared with that in patients with normal kidney function. The kidney function–specific cut-off values were determined as 14, 18 and 48 ng/L for patients with eGFR >60, 60–30 and <30 mL/min/1.73 m2, respectively. Using the novel cut-off values, the specificities for diagnosing AMI in participants with different levels of kidney dysfunction were remarkably improved (from 9.1%–52.7% to 52.8–63.0%), without compr...