{"id":"e8a1fad3e2f6","type":"article","url":"https://hartvaat.nl/2022/07/01/hoog-sensitief-troponine-en-myocardinfarct-bij-nierfunctiestoornissen/","title":"Hoog-sensitief troponine en myocardinfarct bij nierfunctiestoornissen","title_en":"High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["myocardinfarct","troponine"],"journal":"Kidney international","doi":"10.1016/j.kint.2022.02.019","source_url":"https://doi.org/10.1016/j.kint.2022.02.019","authors":["Peter J Gallacher","Eve Miller-Hodges","Anoop S V Shah","Tariq E Farrah","Nynke Halbesma","James P Blackmur","Andrew R Chapman","Philip D Adamson","Atul Anand","Fiona E Strachan","Amy V Ferry","Kuan Ken Lee","Colin Berry","Iain Findlay","Anne Cruickshank","Alan Reid","Alasdair Gray","Paul O Collinson","Fred S Apple","David A McAllister","Donogh Maguire","Keith A A Fox","Catriona Keerie","Christopher J Weir","David E Newby","Nicholas L Mills","Neeraj Dhaun"],"significance":7,"published":"2022-07-01","source_date":"2022-07-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"This study evaluated the performance of high-sensitivity cardiac troponin I for MI diagnosis in patients with kidney impairment, addressing the clinical challenge of distinguishing acute ischemic injury from chronic troponin elevation in CKD.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht het nut van hoog-sensitief troponine I bij de diagnose van myocardinfarct bij patiënten met nierfunctiestoornissen. Ondanks chronisch verhoogde troponinewaarden bleef de diagnostische nauwkeurigheid behouden, mits aangepaste afkapwaarden worden gebruikt.","abstract_original":"The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in the diagnosis of myocardial infarction in patients with kidney impairment is unclear. Here, we describe implementation of hs-cTnI testing on the diagnosis, management, and outcomes of myocardial infarction in patients with and without kidney impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized controlled trial were included in this pre-specified secondary analysis. Kidney impairment was defined as an eGFR under 60mL/min/1.73m2. The index diagnosis and primary outcome of type 1 and type 4b myocardial infarction or cardiovascular death at one year were compared in patients with and without kidney impairment following implementation of hs-cTnI assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 patients (mean age 61 years; 47% women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th centile in 46% and 16% of patients with and without kidney impairment. Implementation increased the diagnosis of type 1 infarction from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without kidney impairment (both significant). Patients with kidney impairment and type 1 myocardial infarction were less likely to undergo coronary revascularization (26% versus 53%) or receive dual anti-platelets (40% versus 68%) than those without kidney impairment, and this did not change post-implementation. In patients with hs-cTnI above the 99th centile, the primary outcome occurred twice as often in those with kidney impairment compared to those without (24% versus 12%, hazard ratio 1.53, 95% confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without kidney impairment."}