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A more appropriate cardiac troponin T level that can predict outcomes in end-stage renal disease patients with acute coronary syndrome.

Ryu DR, Park JT, Chung JH, Song EM, Roh SH, Lee JM, An HR, Yu M, Pyun WB, Shin GJ, Kim SJ, Kang DH, Choi KB - Yonsei Med. J. (2011)

Bottom Line: We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea.

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 ≥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 ≥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.

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Related in: MedlinePlus

Kaplan-Meier survival curves according to initial cardiac troponin T (cTnT) levels. (A) The all-cause mortality rate in the group with initial cTnT ≥0.35 ng/mL is significantly higher compared to the other groups by log-rank test (p<0.001). (B) The cardiovascular mortality rate in the group with initial cTnT ≥0.35 ng/mL is also significantly higher than in the other groups (p<0.001).
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Figure 2: Kaplan-Meier survival curves according to initial cardiac troponin T (cTnT) levels. (A) The all-cause mortality rate in the group with initial cTnT ≥0.35 ng/mL is significantly higher compared to the other groups by log-rank test (p<0.001). (B) The cardiovascular mortality rate in the group with initial cTnT ≥0.35 ng/mL is also significantly higher than in the other groups (p<0.001).

Mentions: Since the 99th percentile and cut-off value of cTnT for AMI in the general population are known to be 0.01 ng/mL and 0.1 ng/mL,15 respectively, and the summation of sensitivity and specificity was shown to be highest at 0.35 ng/mL in the current study, the enrolled patients were divided into four groups on the basis of initial cTnT concentrations: 1) cTnT≤0.01 ng/mL; 2) 0.01<cTnT<0.1 ng/mL; 3) 0.1≤cTnT<0.35 ng/mL; and 4) cTnT≥0.35 ng/mL. Kaplan-Meier survival analysis showed a statistically significant difference in all-cause mortality for the group with initial >cTnT 0.35 ng/mL compared to the other groups (log rank; p<0.001). This effect was more prominent in cardiovascular mortality (Fig. 2).


A more appropriate cardiac troponin T level that can predict outcomes in end-stage renal disease patients with acute coronary syndrome.

Ryu DR, Park JT, Chung JH, Song EM, Roh SH, Lee JM, An HR, Yu M, Pyun WB, Shin GJ, Kim SJ, Kang DH, Choi KB - Yonsei Med. J. (2011)

Kaplan-Meier survival curves according to initial cardiac troponin T (cTnT) levels. (A) The all-cause mortality rate in the group with initial cTnT ≥0.35 ng/mL is significantly higher compared to the other groups by log-rank test (p<0.001). (B) The cardiovascular mortality rate in the group with initial cTnT ≥0.35 ng/mL is also significantly higher than in the other groups (p<0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104442&req=5

Figure 2: Kaplan-Meier survival curves according to initial cardiac troponin T (cTnT) levels. (A) The all-cause mortality rate in the group with initial cTnT ≥0.35 ng/mL is significantly higher compared to the other groups by log-rank test (p<0.001). (B) The cardiovascular mortality rate in the group with initial cTnT ≥0.35 ng/mL is also significantly higher than in the other groups (p<0.001).
Mentions: Since the 99th percentile and cut-off value of cTnT for AMI in the general population are known to be 0.01 ng/mL and 0.1 ng/mL,15 respectively, and the summation of sensitivity and specificity was shown to be highest at 0.35 ng/mL in the current study, the enrolled patients were divided into four groups on the basis of initial cTnT concentrations: 1) cTnT≤0.01 ng/mL; 2) 0.01<cTnT<0.1 ng/mL; 3) 0.1≤cTnT<0.35 ng/mL; and 4) cTnT≥0.35 ng/mL. Kaplan-Meier survival analysis showed a statistically significant difference in all-cause mortality for the group with initial >cTnT 0.35 ng/mL compared to the other groups (log rank; p<0.001). This effect was more prominent in cardiovascular mortality (Fig. 2).

Bottom Line: We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea.

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 ≥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 ≥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.

Show MeSH
Related in: MedlinePlus