MO445: Implications of Cardiac Biomarkers in Patients With Renal Insufficiency on Probability of Coronary Angiography and Subsequent Cardiovascular Outcomes

Abstract

Abstract BACKGROUND AND AIMS Renal insufficiency is associated with an increased risk of cardiovascular morbidity and mortality. Although cardiac troponin remains essential marker for the diagnosis of myocardial injury in the general population, the diagnostic utility remains uncertain in patients with renal insufficiency. We examined the likelihood of coronary angiography and the risk of myocardial infarction after hospitalization with elevated troponin levels in patients with renal insufficiency. METHOD Based on data from multiple Danish nationwide healthcare registries, all hospitalized patients with elevated troponin I or T were identified between 2000 and 2021. Patients with age < 18 years, estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2 and patients hospitalized with myocardial infarction < 30 days prior to the index were excluded. Renal function was calculated based on preceding plasma creatinine using the CKD-EPI equation. The probability of being referred for coronary angiography was computed across strata of renal insufficiency [eGFR (mL/min/1.73m2) 59–45, 44–30, 29–15 and < 15, respectively] based on multiple Cox regression calculating hazard ratios for 30-day likelihood of coronary angiography, with subsequent comparison of cumulative risk and hazard ratios for myocardial infarction using the Aalen-Johansen estimator and multiple Cox regression, respectively. RESULTS In total 57 044 patients were included in the study. Patients were predominantly male (53%, n = 30 222), with a median age of 81 years (IQR 74–87 years). eGFR strata (%): 59–45: 46.8%; 44–30: 30.6%; 29–15; 15.6%; <15: 7.%. Cardiovascular comorbidity was substantial; 47.1% of patients had a history of hypertension, 20.5%% of patients had a history of heart failure, 26.6% of patients had a history of diabetes and 25.3% of patients had a history of ischemic heart disease. Hazard ratios for 30-day likelihood of coronary angiography were 1.26 [95% confidence interval (CI) 1.10–1.44] for eGFR 15–29 mL/min/1.73m2, 2.00 (95% CI 1.77–2.25) for eGFR 30–44 mL/min/1.73m2 and 2.95 (95% CI 2.63–3.31) for eGFR 45–59 mL/min/1.73m2, using eGFR < 15 as reference. Subsequent cumulative risk of myocardial infarction is shown in Figure 1. Hazard ratios for risk of myocardial infarction were 0.86 (95% CI 0.71–1.03) for eGFR 15–29 mL/min/1.73m2, 0.58 (95% CI 0.49–0.69) for eGFR 30–44 mL/min/1.73m2 and 0.49 (95% CI 0.42–0.58) for eGFR 45–59 mL/min/1.73m2, using eGFR < 15 as reference. CONCLUSION In patients with elevated troponin levels, renal insufficiency is associated with an incrementally decreased probability of coronary angiography despite a graded proportional increase in the risk of subsequent myocardial infarction.