Prediction of hemodynamically significant coronary artery disease using troponin I in hemodialysis patients presenting with chest pain: A case-control study.
OBJECTIVE
Controversy exists regarding utility of cardiac troponin I (cTnI) in predicting significant coronary artery disease (CAD) in hemodialysis (HD) patients with chest pain and no acute ischemia on electrocardiogram (non-ST segment elevation myocardial infarction, non-STEMI). We sought to determine if cTnI elevation predicts significant CAD (>70% stenosis) in these patients.


METHODS
Ninety patients with non-STEMI referred for cardiac catheterization were included, divided equally into HD and non-HD groups.


RESULTS
Mean age and baseline characteristics were not significantly different between groups, except for left ventricular hypertrophy which was higher in HD patients (56 vs. 27%, p = 0.012). Initial cTnI correlated with obstructive CAD and was stratified into <0.3 and >0.3 ng/ml. By logistic regression, cTnI >0.3 ng/ml was not predictive of CAD in HD patients [odds ratio = 0.87 (95% CI 0.19-4.0), p = 0.8], while non-HD patients had an increased risk of CAD if first cTnI was >0.3 ng/ml [odds ratio = 1.461 (95% CI 1.01-2.11), p = 0.04] as expected. Sensitivity, specificity, negative and positive predictive values of cTnI in predicting obstructive CAD were better in non-HD patients.


CONCLUSIONS
cTnI in these patients had no predictive value for obstructive CAD. This contrasts with the general population, suggesting a higher index of suspicion for high-grade CAD irrespective of cTnI levels in HD patients.
Badero
Olurotimi J
OJ
Division of Cardiology, SUNY Downstate Medical Center Brooklyn, Brooklyn, NY 11203, USA.
Salifu
Moro O
MO
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I