title: Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T.
abstract: BACKGROUND
  The objective of this study was to examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for acute myocardial infarction (AMI) in patients with renal insufficiency, since this population has a high incidence of non-AMI elevations of hs-cTnT.
  
  
  METHODS
  In this prospective study, we enrolled 2249 consecutive patients presenting with chest pain in the emergency department (ED), of whom 19.5% had an estimated glomerular filtration rate (eGFR)cys of <60 mL·min-1 (1.73 m2)-1. Hs-cTnT levels were measured blindly at presentation.
  
  
  RESULTS
  Of the patients, 1108 (49.3%) were diagnosed as having AMI [321 with non-ST segment elevation myocardial infarction (NSTEMI)]. In patients whose final diagnosis was not AMI, there was a low but significant correlation between hs-cTnT and renal function [eGFRcys, r=-0.43 (-0.48, -0.38), p<0.001; eGFRcreat, r=-0.33 (-0.38, -0.27), p<0.001]. The area under the curve of the receiver operating characteristic (AUC) for hs-cTnT to diagnose AMI was 0.93 in patients with eGFRcys levels of <30 mL·min-1 (1.73 m2)-1, and AUCs did not vary significantly according to eGFR categories. On the basis of the ROC curve, the optimal threshold value for hs-cTnT was 143.6 ng·L-1 to diagnose AMI in patients with eGFRcys of <30 mL·min-1 (1.73 m2)-1, with a sensitivity of 83% and a specificity of 91%; 54.1 ng·L-1 in patients with eGFRcys between 30 and 59 mL·min-1, with a sensitivity of 90% and a specificity of 87%; 30.0 ng·L-1 in patients with eGFRcys between 60 and 89 mL·min-1, with a sensitivity of 89% and a specificity of 85%; and 20.3 ng·L-1 in patients with eGFRcys ≥90 mL·min-1 (1.73 m2)-1, with a sensitivity of 92% and a specificity of 88%. The same observations were done for the diagnosis of NSTEMI.
  
  
  CONCLUSIONS
  Using a higher hs-cTnT cut-off value based on eGFR level is necessary for accurate diagnosis of AMI or NSTEMI in patients with renal insufficiency.
authors.forename: Hualan
authors.initials: H
authors.lastname: Huang
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhu
authors.forename: Weiqing
authors.initials: W
authors.lastname: Wang
authors.forename: Hong
authors.initials: H
authors.lastname: Yi
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Du
authors.forename: Xin
authors.initials: X
authors.lastname: Nie
authors.forename: Yong
authors.initials: Y
authors.lastname: He
authors.forename: Haolan
authors.initials: H
authors.lastname: Song
authors.forename: Qiang
authors.initials: Q
authors.lastname: Miao
authors.forename: Lanlan
authors.initials: L
authors.lastname: Wang
authors.forename: Guixing
authors.initials: G
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism; D051437:Renal Insufficiency / Q000150:complications*; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000378:metabolism*
chemical_list: D020107:Troponin T