The significance of elevated troponin T in patients with nondialysis-dependent renal insufficiency: a validation with coronary angiography.
BACKGROUND
Patients with elevated troponin are at high risk of adverse outcomes, future cardiac events, and are more likely to have hemodynamically significant coronary artery stenoses. Elevated troponin T (cTnT) in patients with poor renal function portends a poor prognosis; however, findings of significant coronary artery disease (CAD) by coronary angiography have not been demonstrated in patients with poor renal function and elevated cTnT.


OBJECTIVE
The purpose of this study was to correlate the angiographic findings of patients with elevated cTnT with respect to renal function in patients with nondialysis-dependent renal insufficiency.


METHODS
We retrospectively identified 342 patients with elevated cTnT who underwent coronary angiography in the setting of acute coronary syndrome. Patients were divided into poor (< 40 ml/min) and normal (> 40 ml/min) renal function by measuring their glomerular filtration rate. Our primary outcome was CAD stenosis, defined as epicardial stenosis > or = 70%. Secondary outcomes were rates of contrast nephropathy, initiation of hemodialysis, revascularization, length of stay (LOS), and in-hospital mortality.


RESULTS
There was no significant difference in the prevalence of CAD between patients who had positive cTnT with poor renal function versus patients with positive cTnT and normal renal function (87.1 vs. 89.7%, p = 0.54). This finding persisted after stratifying by age. Patients with impaired renal function had a higher mortality, longer LOS, and a higher rate contrast nephropathy requiring hemodialysis.


CONCLUSIONS
The association between elevated cTnT and significant CAD stenosis does not vary with renal function.
Heitner
John F
JF
Department of Medicine, Division of Cardiology, New York Methodist Hospital, 506 6th Street, 2 Buckley Pavilion, Brooklyn, NY 11215, USA. heitn001@mc.duke.edu
Curtis
Jeptha P
JP
Haq
Salman A
SA
Corey
G Ralph
GR
Newby
L Kristin
LK
Jollis
James G
JG
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D023921:Coronary Stenosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D003402:Creatine Kinase / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D051437:Renal Insufficiency / Q000097:blood* / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T; D003402:Creatine Kinase