Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency

Hsu, Cheng-Kai; Wu, I‐Wen; Chen, Yih-Ting; Peng, Chia-Huei; Tseng, Yi-Ju; Chen, Yung‐Chang; Hung, Ming‐Jui; Kao, Yu-Cheng

doi:10.1080/0886022x.2020.1845732

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…. " which is consistent with the present results (hs-cTnT was above 140 ng/l in 91.6% of CABG patients) [8]. This leads to the question of the usefulness of hs-cTnT determination when a possible threshold for intervention-related ischemia is exceeded in more than 90% and thus the diagnosis is essentially based on ECG and/or echocardiographic findings.…”

Section: Discussionsupporting

confidence: 90%

“…In what is, to our knowledge, the only analysis of postoperative (after CABG) hs-cTnT to verify type 5 MI criteria, the authors found that isolated hs-cTnT raise was not related to mortality [8]. In contrast, if ECG and/or echocardiographic criteria were present, hs-cTnT elevation above 10 times the URL (> 140 ng/l) was associated with increased 30-day and 1.8-year follow-up mortality, thus apparently confirming guidelines.…”

Section: Discussionmentioning

confidence: 86%

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Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction

Niclauss¹,

Pfister²,

Delay

et al. 2021

Preprint

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Background and aim of the study Guidelines on myocardial revascularization indicate for type V myocardial infarction (MI) that postoperative troponin elevations need not be exclusively ischemic but may also be caused by direct epicardial injury. Additional complexity arises from the introduction of high-sensitive troponin markers. The present study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. Methods Type of surgery, potential factors affecting the postoperative hs-cTnT increase, and possible thresholds indicative of type V MI were analyzed. Results Among 400 included patients, 2.8% had intervention-related ischemia analogous to the type V MI definition. Receiver-operating characteristics confirmed good discriminatory power for hs-cTnT and creatine kinase myocardial band (CK-MB), with ischemia indicating thresholds for hs-cTnT (1705.5 ng/l) and for CK-MB (113 U/l). The median postoperative hs-cTnT/CK-MB increase differed significantly depending on the type of surgery, with the highest increase after mitral valve and the lowest after off-pump coronary surgery. Regression analysis confirmed Maze procedure (p<0.001), cardiopulmonary bypass time (p=0.03), emergency indications (p= 0.01) and blood transfusion (p=0.02) as significant factors associated with hs-cTnT increase. In contrast, CK-MB increase was also associated with mortality (p=0.002). Intra-pericardial defibrillation was the only ischemia-independent factor additionally associated with proposed thresholds (p<0.001). Conclusions The present results confirm the influence of the type of surgery and other intervention-related parameters on the postoperative hs-cTnT increase. Type V MI-indicating thresholds may require reassessment, especially using high-sensitive markers.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 86%

Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction

Niclauss¹,

Pfister²,

Delay

et al. 2021

Preprint

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“…Studies in nonsurgical patients have shown that the utility of the marker for the diagnosis of acute coronary syndrome in the presence of renal insufficiency is limited. 6 , 7 In the surgical patients studied here, there was also some association in this regard. In addition, the maze procedure, emergency intervention, blood transfusion, cardiopulmonary bypass time, and intrapericardial defibrillation (and correspondingly for the CABG subgroup, high‐risk patients in addition to emergency intervention and prolonged cardiopulmonary bypass time) were identified as independent parameters affecting hs‐cTnT release.…”

Section: Discussionmentioning

confidence: 51%

“…To complicate matters, other factors influence troponin increase. Studies in nonsurgical patients have shown that the utility of the marker for the diagnosis of acute coronary syndrome in the presence of renal insufficiency is limited 6,7 . In the surgical patients studied here, there was also some association in this regard.…”

Section: Discussionmentioning

confidence: 62%

Usefulness of postoperative high‐sensitive troponin T measurement and implications for defining type 5 infarction

Niclauss

Pfister

Delay

et al. 2021

Journal of Cardiac Surgery

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Background and aim of the study: Guidelines indicate for type 5 myocardial infarction (MI) that postoperative troponin need not be exclusively ischemic but may also be caused by epicardial injury. Complexity arises from the introduction of highsensitive troponin. This study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. Methods:The median enzyme increase of different cardiac operations was compared. Linear regression analyses were used to determine correlations between enzyme rise and independent parameters. Receiver-operating characteristics (ROC) served to evaluate the discriminatory power of enzyme rise in detecting ischemia and to determine possible thresholds.Results: Among 400 patients, 2.8% had intervention-related ischemia analogous to type 5 MI definition. The median postoperative hs-cTnT/creatine kinase myocardial band (CK-MB) increase varied according to types of surgery, with highest increase after mitral valve and lowest after off-pump coronary surgery. After ruling out patients with preoperatively elevated hs-cTnT, regression analysis confirmed Maze procedure (p < .001), intra-pericardial defibrillation (p = .002), emergency intervention (p = .01), blood transfusions (p = .02), and cardiopulmonary bypass time (p = .03) as significant factors associated with hs-cTnT increase. In addition, CK-MB increase was associated with mortality (p = .002).ROC confirmed good discriminatory power for hs-cTnT and CK-MB with ischemiaindicating thresholds of 1705.5 ng/L (hs-cTnT) and 113 U/L (CK-MB) considering different types of operations. Conclusions:The Influence of the type of surgery and intervention-related parameters on hs-cTnT increase was confirmed. Potential thresholds indicating perioperative ischemia appear to be significantly elevated for high sensitive markers.

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“…Many of the causes of elevated troponin are chronic, for example, chronic renal failure (CRF) [2,3]. As many as 33-43% of patients with CRF may have increased troponin concentration [4].…”

mentioning

confidence: 99%

In Pulmonary Embolism an Interpretation of Systolic Blood Pressure, Troponin (And Other Important Parameters) Depends on Their Previous Values and Comorbidities

Koraćević

Đorđević²

2022

FU Med Biol

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We reviewed several important parameters in pulmonary thromboembolism (PTE) and showed how not only absolute values but also relative are relevant in clinical practice. The vast majority of parameters depend both on previous values and co-morbidities; failure to realize this can result in misclassification of a patient and inappropriate treatment. For example, the absolute value systolic blood pressure (BP) less than 90 mmHg is crucial for urgent treatment (e.g. thrombolysis); obviously, the same admission systolic BP (sBP) of 87 mmHg may not have the same significance if previous usual sBP was also 87 mmHg or it was 220 mmHg. Moreover, cardiac troponin is also very important for the risk stratification; the same troponin concentration ought not to be interpreted equally if it is due to acute pulmonary thromboembolism or if it is chronic and due to e.g. renal failure. The interpretation of important dichotomous parameters (normal or pathologic values) in PTE does depend on previous values (if available) and co-morbidities. This principle should be recognized and used in clinical practice, while risk-stratifying patients.

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Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency

Cited by 6 publications

References 34 publications

Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction

Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction

Usefulness of postoperative high‐sensitive troponin T measurement and implications for defining type 5 infarction

In Pulmonary Embolism an Interpretation of Systolic Blood Pressure, Troponin (And Other Important Parameters) Depends on Their Previous Values and Comorbidities

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