Abstract
Acute myocardial infarction (MI) represents one of the most common hospital encounters, with significant short-term and long-term morbidity and mortality, and frequently occurs in patients with chronic kidney disease (CKD). Cardiac troponin is an exquisitely sensitive biomarker for myocardial injury and plays an essential role in the diagnosis, risk-stratification, and management of MI. In 2017, the United States Food and Drug Administration approved Roche Diagnostics' 5th generation high-sensitivity cardiac troponin (hs-cTn) for clinical use. Whilst the improved analytical sensitivity of these new high-sensitivity troponin assays facilitate early diagnosis of MI, it also frequently identifies troponin elevations above the conventional reference threshold in the context of non-coronary conditions such as renal dysfunction, and can represent a major diagnostic challenge to clinicians. Furthermore, the optimal management strategy of patients with troponin elevation and high comorbidity burden, a common issue in patients with CKD, remains undefined. In recent years, there has been substantial research and progress undertaken in this rapidly evolving area. In this review, we aim to provide clinicians with an overview of hs-cTn in the setting of CKD as well as an update on its application and the particular considerations involved in the management of myocardial infarction, stable coronary artery disease and myocardial injury in this high risk population.
Highlights
Acute myocardial infarction (MI), which is most commonly due to atherosclerotic coronary artery disease (CAD), is still the major cause of cardiovascular mortality and morbidity worldwide (Benjamin et al, 2019)
This review aims to provide an overview of high-sensitivity cardiac troponin (cTn) (hs-cTn) with a particular focus on patients with chronic kidney disease (CKD)
It will provide a clinically focused update on the application of hs-cTn as well as considerations involved in the assessment and management of myocardial infarction, stable CAD and myocardial injury in this high risk population
Summary
Acute myocardial infarction (MI), which is most commonly due to atherosclerotic coronary artery disease (CAD), is still the major cause of cardiovascular mortality and morbidity worldwide (Benjamin et al, 2019). Its superior precision and sensitivity facilitates early diagnosis of MI, it posed unique challenges to clinicians as it identifies elevated troponin levels above the conventional reference threshold in over 50% of patients with renal dysfunction and final admission diagnoses other than acute MI (Chen et al, 2013; Flores-Solís and Hernández-Domínguez, 2014; Pfortmueller et al, 2013; Twerenbold et al, 2015). This review aims to provide an overview of hs-cTn with a particular focus on patients with CKD. It will provide a clinically focused update on the application of hs-cTn as well as considerations involved in the assessment and management of myocardial infarction, stable CAD and myocardial injury in this high risk population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
