# Hoog-sensitief troponine en myocardinfarct bij nierfunctiestoornissen

*geplaatst 2022-07-01 · Nierziekte · Kidney international · doi 10.1016/j.kint.2022.02.019 · https://hartvaat.nl/2022/07/01/hoog-sensitief-troponine-en-myocardinfarct-bij-nierfunctiestoornissen/*

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.

## English: High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Kidney international, https://doi.org/10.1016/j.kint.2022.02.019. Bijgewerkt 2026-07-03T13:28:55Z. 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.