Jonathan D Knott, Olatunde Ola, Laura De Michieli, Ashok Akula, Ramila A Mehta, Marshall Dworak, Erika Crockford, Ronstan Lobo, Joshua Slusser, Nicholas Rastas, Swetha Karturi, Scott Wohlrab, David O Hodge, Eric Grube, Tahir Tak, Charles Cagin, Rajiv Gulati, Yader Sandoval, Allan S Jaffe
{"title":"使用高敏心肌肌钙蛋白 T 诊断肾功能衰竭患者的急性心肌梗死。","authors":"Jonathan D Knott, Olatunde Ola, Laura De Michieli, Ashok Akula, Ramila A Mehta, Marshall Dworak, Erika Crockford, Ronstan Lobo, Joshua Slusser, Nicholas Rastas, Swetha Karturi, Scott Wohlrab, David O Hodge, Eric Grube, Tahir Tak, Charles Cagin, Rajiv Gulati, Yader Sandoval, Allan S Jaffe","doi":"10.1093/ehjacc/zuae079","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Diagnosing myocardial infarction (MI) in patients with chronic kidney disease (CKD) is difficult as they often have increased high-sensitivity cardiac troponin T (hs-cTnT) concentrations.</p><p><strong>Methods and results: </strong>Observational US cohort study of emergency department patients undergoing hs-cTnT measurement. Cases with ≥1 hs-cTnT increase > 99th percentile were adjudicated following the Fourth Universal Definition of MI. Diagnostic performance of baseline and serial 2 h hs-cTnT thresholds for ruling-in acute MI was compared between those without and with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). The study cohort included 1992 patients, amongst whom 501 (25%) had CKD. There were 75 (15%) and 350 (70%) patients with CKD and 80 (5%) and 351 (24%) without CKD who had acute MI and myocardial injury. In CKD patients with baseline hs-cTnT thresholds of ≥52, >100, >200, or >300 ng/L, positive predictive values (PPVs) for MI were 36% (95% CI 28-45), 53% (95% CI 39-67), 73% (95% CI 50-89), and 80% (95% CI 44-98), and in those without CKD, 61% (95% CI 47-73), 69% (95% CI 49-85), 59% (95% CI 33-82), and 54% (95% CI 25-81). In CKD patients with a 2 h hs-cTnT delta of ≥10, >20, or >30 ng/L, PPVs were 66% (95% CI 51-79), 86% (95% CI 68-96), and 88% (95% CI 68-97), and in those without CKD, 64% (95% CI 50-76), 73% (95% CI 57-86), and 75% (95% CI 58-88).</p><p><strong>Conclusion: </strong>Diagnostic performance of standard baseline and serial 2 h hs-cTnT thresholds to rule-in MI is suboptimal in CKD patients. It significantly improves when using higher baseline thresholds and delta values.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnosis of acute myocardial infarction in patients with renal failure using high-sensitivity cardiac troponin T.\",\"authors\":\"Jonathan D Knott, Olatunde Ola, Laura De Michieli, Ashok Akula, Ramila A Mehta, Marshall Dworak, Erika Crockford, Ronstan Lobo, Joshua Slusser, Nicholas Rastas, Swetha Karturi, Scott Wohlrab, David O Hodge, Eric Grube, Tahir Tak, Charles Cagin, Rajiv Gulati, Yader Sandoval, Allan S Jaffe\",\"doi\":\"10.1093/ehjacc/zuae079\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Diagnosing myocardial infarction (MI) in patients with chronic kidney disease (CKD) is difficult as they often have increased high-sensitivity cardiac troponin T (hs-cTnT) concentrations.</p><p><strong>Methods and results: </strong>Observational US cohort study of emergency department patients undergoing hs-cTnT measurement. Cases with ≥1 hs-cTnT increase > 99th percentile were adjudicated following the Fourth Universal Definition of MI. Diagnostic performance of baseline and serial 2 h hs-cTnT thresholds for ruling-in acute MI was compared between those without and with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). The study cohort included 1992 patients, amongst whom 501 (25%) had CKD. There were 75 (15%) and 350 (70%) patients with CKD and 80 (5%) and 351 (24%) without CKD who had acute MI and myocardial injury. In CKD patients with baseline hs-cTnT thresholds of ≥52, >100, >200, or >300 ng/L, positive predictive values (PPVs) for MI were 36% (95% CI 28-45), 53% (95% CI 39-67), 73% (95% CI 50-89), and 80% (95% CI 44-98), and in those without CKD, 61% (95% CI 47-73), 69% (95% CI 49-85), 59% (95% CI 33-82), and 54% (95% CI 25-81). In CKD patients with a 2 h hs-cTnT delta of ≥10, >20, or >30 ng/L, PPVs were 66% (95% CI 51-79), 86% (95% CI 68-96), and 88% (95% CI 68-97), and in those without CKD, 64% (95% CI 50-76), 73% (95% CI 57-86), and 75% (95% CI 58-88).</p><p><strong>Conclusion: </strong>Diagnostic performance of standard baseline and serial 2 h hs-cTnT thresholds to rule-in MI is suboptimal in CKD patients. It significantly improves when using higher baseline thresholds and delta values.</p>\",\"PeriodicalId\":11861,\"journal\":{\"name\":\"European Heart Journal: Acute Cardiovascular Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-07-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal: Acute Cardiovascular Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjacc/zuae079\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal: Acute Cardiovascular Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ehjacc/zuae079","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:慢性肾脏病(CKD)患者的高敏心肌肌钙蛋白 T(hs-cTnT)浓度通常会升高,因此诊断慢性肾脏病患者的心肌梗死(MI)非常困难:方法:对接受 hs-cTnT 测量的急诊科 (ED) 患者进行美国观察性队列研究。根据第四版心肌梗死通用定义,对 hs-cTnT 升高超过 1 次且超过第 99 百分位数的病例进行判定。比较了无慢性肾功能衰竭和有慢性肾功能衰竭(eGFR)患者的基线和连续 2 小时 hs-cTnT 阈值在判定急性心肌梗死方面的诊断性能:研究队列包括 1992 名患者,其中 501 人(25%)患有慢性肾脏病。分别有 75 名(15%)和 350 名(70%)患有慢性肾脏病的患者和 80 名(5%)和 351 名(24%)未患有慢性肾脏病的患者发生了急性心肌梗死和心肌损伤。在基线 hs-cTnT 阈值大于 52、大于 100、大于 200 或大于 300 纳克/升的慢性肾脏病患者中,心肌梗死的 PPV 分别为 36%(95% CI 28-45)、53%(95% CI 39-67)、73%(95% CI 50-89)和 80%(95% CI 44-98);在无慢性肾脏病的患者中,心肌梗死的 PPV 分别为 61%(95% CI 47-73)、69%(95% CI 49-85)、59%(95% CI 33-82)和 54%(95% CI 25-81)。对于 2 小时 hs-cTnT delta >10、>20 或 >30 纳克/升的 CKD 患者,PPV 分别为 66%(95% CI 51-79)、86%(95% CI 68-96)和 88%(95% CI 68-97);对于无 CKD 患者,PPV 分别为 64%(95% CI 50-76)、73%(95% CI 57-86)和 75%(95% CI 58-88):结论:标准基线和连续 2 小时 hs-cTnT 阈值在排除慢性肾脏病患者心肌梗死方面的诊断效果并不理想。如果使用更高的基线阈值和 delta 值,诊断效果会明显改善。
Diagnosis of acute myocardial infarction in patients with renal failure using high-sensitivity cardiac troponin T.
Aims: Diagnosing myocardial infarction (MI) in patients with chronic kidney disease (CKD) is difficult as they often have increased high-sensitivity cardiac troponin T (hs-cTnT) concentrations.
Methods and results: Observational US cohort study of emergency department patients undergoing hs-cTnT measurement. Cases with ≥1 hs-cTnT increase > 99th percentile were adjudicated following the Fourth Universal Definition of MI. Diagnostic performance of baseline and serial 2 h hs-cTnT thresholds for ruling-in acute MI was compared between those without and with CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). The study cohort included 1992 patients, amongst whom 501 (25%) had CKD. There were 75 (15%) and 350 (70%) patients with CKD and 80 (5%) and 351 (24%) without CKD who had acute MI and myocardial injury. In CKD patients with baseline hs-cTnT thresholds of ≥52, >100, >200, or >300 ng/L, positive predictive values (PPVs) for MI were 36% (95% CI 28-45), 53% (95% CI 39-67), 73% (95% CI 50-89), and 80% (95% CI 44-98), and in those without CKD, 61% (95% CI 47-73), 69% (95% CI 49-85), 59% (95% CI 33-82), and 54% (95% CI 25-81). In CKD patients with a 2 h hs-cTnT delta of ≥10, >20, or >30 ng/L, PPVs were 66% (95% CI 51-79), 86% (95% CI 68-96), and 88% (95% CI 68-97), and in those without CKD, 64% (95% CI 50-76), 73% (95% CI 57-86), and 75% (95% CI 58-88).
Conclusion: Diagnostic performance of standard baseline and serial 2 h hs-cTnT thresholds to rule-in MI is suboptimal in CKD patients. It significantly improves when using higher baseline thresholds and delta values.
期刊介绍:
The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes.
Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.