title: Cardiac troponin risk stratification based on 99th percentile reference cutoffs in patients with ischemic symptoms suggestive of acute coronary syndrome: influence of estimated glomerular filtration rates.
abstract: Cardiac troponin (cTn) assays were compared in 490 unselected patients with symptoms suggestive of acute coronary syndrome with varying renal functions for risk stratification. cTnI (Dade, Newark, NJ; Beckman, Chaska, MN; and Tosoh, South San Francisco, CA) and cTnT (Roche, Indianapolis, IN) measurements and estimated glomerular filtration rates (eGFRs) were obtained and classified along sex-derived cutoffs. The cTn levels were increased in 14% to 25% of patients. In 68%, the eGFR was 60 mL/min/1.73 m2 or more; in 17%, it was between 41 and 59; and in 15%, it was 40 or less. There were 36 deaths and 9 cardiac events. Risk stratification was significant at 30 days and 6 months (P < or = .05). Relative risks ranged from 3.1 to 3.7, and cumulative event rates ranged from 22.4% to 24.2% for an increased troponin level compared with 6.7% to 8.9% for a normal level. The 6-month event rate with an eGFR less than 60 mL/min/1.73 m2 and an increased troponin level ranged from 29.9% to 50.8% compared with 4.9% to 6.6% for a normal troponin level and an eGFR greater than 60 mL/min/1.73 m2 (P < .05). The eGFR in combination with an increased cTn level demonstrated the most powerful stratification.
authors: The Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and the University of Minnesota School of Medicine, Minneapolis, MN 55415, USA.
authors: Fred S
authors: FS
authors: Apple
authors: Lesly A
authors: LA
authors: Pearce
authors: Patrick J
authors: PJ
authors: Doyle
authors: Angela P
authors: AP
authors: Otto
authors: MaryAnn M
authors: MM
authors: Murakami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006403:Hematologic Tests / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin