Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jan 21;12(2):276.
doi: 10.3390/diagnostics12020276.

Troponin Cut-Offs for Acute Myocardial Infarction in Patients with Impaired Renal Function-A Systematic Review and Meta-Analysis

Jan Kampmann  1   2 , James Heaf  3 , Christian Backer Mogensen  2   4 , Andreas Kristian Pedersen  2 , Jeff Granhøj  1 , Hans Mickley  5 , Frans Brandt  1   2
Affiliations
Review

Troponin Cut-Offs for Acute Myocardial Infarction in Patients with Impaired Renal Function-A Systematic Review and Meta-Analysis

Jan Kampmann et al. Diagnostics (Basel). .

Abstract

Identifying acute myocardial infarction in patients with renal disease is notoriously difficult, due to atypical presentation and chronically elevated troponin. The aim of this study was to identify a specific troponin T/troponin I cut-off value for diagnosis of acute myocardial infarction in patients with renal impairment via meta-analysis. Two investigators screened 2590 publications from MEDLINE, Embase, PubMed, Web of Science, and the Cochrane library. Only studies that investigated alternative cut-offs according to renal impairment were included. Fifteen articles fulfilled the inclusion criteria. Six studies were combined for meta-analysis. The manufacturer's upper reference level for troponin T is 14 ng/L. Based on the meta-analyses, cut-off values for troponin in patients with renal impairment with myocardial infarction was 42 ng/L for troponin I and 48 ng/L for troponin T. For patients on dialysis the troponin T cut-off is even higher at 239 ng/L. A troponin I cut-off value for dialysis patients could not be established due to lack of data. The 15 studies analyzed showed considerable diversity in study design, study population, and the definition of myocardial infarction. Further studies are needed to define a reliable troponin cut-off value for patients with kidney disease, especially in dialysis patients, and to allow necessary subanalysis.

Keywords: acute myocardial infarction; chronic kidney disease; troponin.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prisma Flow chart of the screened articles for the systematic review of cut-off values for troponin in patients with chronic kidney disease.
Figure 2
Figure 2
QUADAS-2 score for the risk of bias across all studies for the included studies in the systematic review of cut-off values for troponin in patients with chronic kidney disease.
Figure 3
Figure 3
QUADAS-2 score for applicability of bias across all studies for the included studies in the systematic review of cut-off values for troponin in patients with chronic kidney disease.
Figure 4
Figure 4
SROC curve for the optimized troponin cut-off in patients with chronic kidney disease.
Figure 5
Figure 5
SROC curve for the optimized troponin T cut-off for patients not on dialysis.
Figure 6
Figure 6
SROC curve for the optimized troponin T cut-off for patients on dialysis.
Figure 7
Figure 7
SROC curve for the optimized troponin I cut-off for patients without dialysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Thygesen K., Alpert J.S., Jaffe A.S., Chaitman B.R., Bax J.J., Morrow D.A., White D.A. Fourth Universal Definition of Myocardial Infarction. Circulation. 2018;138:e618–e651. doi: 10.1161/CIR.0000000000000617. - DOI - PubMed
    1. DeBella Y.T., Giduma H.D., Light R.P., Agarwal R. Chronic Kidney Disease as a Coronary Disease Equivalent—A Comparison with Diabetes over a Decade. Clin. J. Am. Soc. Nephrol. 2011;6:1385–1392. doi: 10.2215/CJN.10271110. - DOI - PMC - PubMed
    1. Shroff G.R., Frederick P.D., Herzog C.A. Renal failure and acute myocardial infarction: Clinical characteristics in patients with advanced chronic kidney disease, on dialysis, and without chronic kidney disease. A collaborative project of the United States Renal Data System/National Institutes of Health and the National Registry of Myocardial Infarction. Am. Heart J. 2012;163:399–406. doi: 10.1016/j.ahj.2011.12.002. - DOI - PMC - PubMed
    1. Dobre M., Brateanu A., Rashidi A., Rahman M. Electrocardiogram abnormalities and cardiovascular mortality in elderly patients with CKD. Clin. J. Am. Soc. Nephrol. 2012;7:949–956. doi: 10.2215/CJN.07440711. - DOI - PubMed
    1. Ferrara L., Staiano L., Di Fronzo V., Ferrara F., Sforza A., Mancusi C., De Simone G. Type of myocardial infarction presentation in patients with chronic kidney disease. Nutr. Metab. Cardiovasc. Dis. 2015;25:148–152. doi: 10.1016/j.numecd.2014.11.002. - DOI - PubMed