A More Appropriate Cardiac Troponin T Level That Can Predict Outcomes in End-Stage Renal Disease Patients with Acute Coronary Syndrome.
10.3349/ymj.2011.52.4.595
- Author:
Dong Ryeol RYU
1
;
Jung Tak PARK
;
Jung Hwa CHUNG
;
Eun Mi SONG
;
Sun Hee ROH
;
Jeong Min LEE
;
Hye Rim AN
;
Mina YU
;
Wook Bum PYUN
;
Gil Ja SHIN
;
Seung Jung KIM
;
Duk Hee KANG
;
Kyu Bok CHOI
Author Information
1. Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. kbchoi@ewha.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Acute coronary syndrome;
cardiac troponin T;
end-stage renal disease
- MeSH:
Acute Coronary Syndrome/blood/complications/*diagnosis/mortality;
Aged;
Biological Markers/blood;
Female;
Humans;
Kidney Failure, Chronic/blood/complications/*diagnosis/mortality;
Male;
Middle Aged;
Prognosis;
Retrospective Studies;
Sensitivity and Specificity;
Troponin T/*blood
- From:Yonsei Medical Journal
2011;52(4):595-602
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: 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). MATERIALS AND 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 > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration > or =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 > or =0.35 ng/mL.
