Open AccessPrognostic Value of Troponins in Patients with Non‐ST‐segment Elevation Acute Coronary Syndromes and Chronic Kidney Disease
Author(s) -
Melloni Chiara,
Alexander Karen P.,
MilfordBeland Sarah,
Newby L. Kristin,
Szczech Lynda A.,
Pollack Charles V.,
Kirk J. Douglas,
Christenson Robert H.,
Harrington Robert A.,
Gibler W. Brian,
Ohman E. Magnus,
Peterson Eric D.,
Roe Matthew T.
Publication year - 2008
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20210
Subject(s) - medicine , kidney disease , cardiology , renal function , acute coronary syndrome , unstable angina , troponin , myocardial infarction
Background The prognostic value of cardiac troponins (cTn) in patients with non‐ST‐segment elevation acute coronary syndromes (NSTE ACS) and chronic kidney disease (CKD) is debated. Hypothesis We tested the performance of cTnI and cTnT for risk stratification in patients with CKD and evaluated the prognostic significance of cTnI and cTnT elevations by their magnitude across the range of CKD severity. Methods We examined correlations among cTn elevation, CKD, and in‐hospital mortality in 31,586 high‐risk patients with NSTE ACS included in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines initiative (CRUSADE). Cardiac tropinins I and T levels were categorized as ratios of each site's upper limit of normal (ULN) for myocardial necrosis: normal (cTn ratio ⩽1 × ULN), mild (cTn ratio > 1–3 × ULN), and major (cTn ratio > 3 × ULN) elevation. Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease equation. Stages of CKD were categorized as normal to mild (eGFR > 60 mL/min), moderate (eGFR 30–60 mL/min), or severe (eGFR < 30 mL/min). Results Mortality increased more steeply across CKD stages (2.0%–12.9%) than across cTn ratio categories (2.7%–5.4%). In normal or mild CKD, mortality was low regardless of cTn elevations. In moderate CKD, mortality increased incrementally with cTnI (3.3% versus 5.4% versus 7.4%) and cTnT (3.7% versus 5.3% versus 7.3%) elevation. Among severe CKD patients, only major cTn elevations further distinguished risk (cTnI: 10.1% versus 9.7% versus 14.6%; cTnT: 7.0% versus 5.7% versus 14.0%). Conclusions In patients with CKD, cTnI and cTnT perform equally in differentiating short‐term prognosis following NSTE ACS; however, the prognostic impact of cTn is dependent upon the degree of CKD severity. Copyright © 2008 Wiley Periodicals, Inc.