title: A more appropriate cardiac troponin T level that can predict outcomes in end-stage renal disease patients with acute coronary syndrome.
abstract: OBJECTIVE
  Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS).
  
  
  METHODS
  Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis.
  
  
  RESULTS
  AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT ≥0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality.
  
  
  CONCLUSIONS
  Because ESRD patients with an initial cTnT concentration ≥0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are ≥0.35 ng/mL.
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea.
authors.forename: Dong-Ryeol
authors.initials: DR
authors.lastname: Ryu
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Chung
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Song
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Roh
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Hye Rim
authors.initials: HR
authors.lastname: An
authors.forename: Mina
authors.initials: M
authors.lastname: Yu
authors.forename: Wook Bum
authors.initials: WB
authors.lastname: Pyun
authors.forename: Gil Ja
authors.initials: GJ
authors.lastname: Shin
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Kim
authors.forename: Duk-Hee
authors.initials: DH
authors.lastname: Kang
authors.forename: Kyu Bok
authors.initials: KB
authors.lastname: Choi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T