Ballocca Flavia, D'Ascenzo Fabrizio, Moretti Claudio, Diletti Roberto, Budano Carlo, Palazzuoli Alberto, Reed Matthew J, Palmerini Tullio, Dudek Dariusz, Galassi Alfredo, Omedè Pierluigi, Mieghem Nicolas M, Ferenbach David, Pavani Marco, Della Riva Diego, Mills Nick L, Van Domburgh Ron T, Mariani Andrea, Dziewierz Artur, di Cuia Marco, Jan van Geuns Robert, Zijlstra Felix, Bergerone Serena, Marra Sebastiano, Biondi Zoccai Giuseppe, Gaita Fiorenzo
Departement of Cardiology, Division of Internal Medicine, Città Della Salute e della Scienza.
Cardiol J. 2017;24(2):139-150. doi: 10.5603/CJ.a2017.0025. Epub 2017 Mar 10.
Accuracy of high sensitive troponin (hs-cTn) to detect coronary artery disease (CAD) in patients with renal insufficiency is not established. The aim of this study was to evaluate the prognostic role of hs-cTn T and I in patients with chronic kidney disease (CKD).
All consecutive patients with chest pain, renal insufficiency (eGFR < 60 mL/min/1.73 m2) and high sensitive troponin level were included. The predictive value of baseline and interval troponin (hs-cTnT and hs-cTnI) for the presence of CAD was assessed.
One hundred and thirteen patients with troponin I and 534 with troponin T were included, with 95 (84%) and 463 (87%) diagnosis of CAD respectively. There were no differences in clinical, procedural and outcomes between the two assays. For both, baseline hs-cTn values did not differ be-tween patients with/without CAD showing low area under the curve (AUC). For interval levels, hs-cTnI was significantly higher for patients with CAD (0.2 ± 0.8 vs. 8.9 ± 4.6 ng/mL; p = 0.04) and AUC was more accurate for troponin I than hs-cTnT (AUC 0.85 vs. 0.69). Peak level was greater for hs-cTnI in patients with CAD or thrombus (0.4 ± 0.6 vs. 15 ± 20 ng/mL; p = 0.02; AUC 0.87: 0.79-0.93); no differences were found for troponin T assays (0.8 ± 1.5 vs. 2.2 ± 3.6 ng/mL; p = 1.7), with lower AUC (0.73: 0.69-0.77). Peak troponin levels (both T and I) independently predicted all cause death at 30 days.
Patients with CKD presenting with altered troponin are at high risk of coronary disease. Peak level of both troponin assays predicts events at 30 days, with troponin I being more accurate than troponin T. (Cardiol J 2017; 24, 2: 139-150).
高敏肌钙蛋白（hs-cTn）检测肾功能不全患者冠状动脉疾病（CAD）的准确性尚未明确。本研究旨在评估hs-cTn T和I在慢性肾脏病（CKD）患者中的预后作用。
纳入所有连续性胸痛、肾功能不全（估算肾小球滤过率<60 mL/min/1.73 m²）且高敏肌钙蛋白水平升高的患者。评估基线和动态肌钙蛋白（hs-cTnT和hs-cTnI）对CAD存在与否的预测价值。
纳入113例肌钙蛋白I患者和534例肌钙蛋白T患者，分别有95例（84%）和463例（87%）诊断为CAD。两种检测方法在临床、操作和结果方面无差异。对于两者，有/无CAD患者的基线hs-cTn值无差异，曲线下面积（AUC）较低。对于动态水平，CAD患者的hs-cTnI显著更高（0.2±0.8 vs. 8.9±4.6 ng/mL；p = 0.04），肌钙蛋白I的AUC比hs-cTnT更准确（AUC 0.85 vs. 0.69）。CAD或血栓患者的hs-cTnI峰值水平更高（0.4±0.6 vs. 15±20 ng/mL；p = 0.02；AUC 0.87：0.79 - 0.93）；肌钙蛋白T检测无差异（0.8±1.5 vs. 2.2±3.6 ng/mL；p = 1.7），AUC较低（0.73：0.69 - 0.77）。肌钙蛋白峰值水平（T和I）均独立预测30天全因死亡。
CKD患者出现肌钙蛋白改变时患冠心病风险高。两种肌钙蛋白检测的峰值水平均能预测30天事件，肌钙蛋白I比肌钙蛋白T更准确。（《心脏病学杂志》2017年；24卷，第2期：139 - 150页）
