Kidney Week

Abstract: SA-PO917

Outcomes in Patients with Renal Impairment and Myocardial Infarction Identified by High-Sensitivity Cardiac Troponin Testing: A Prespecified Analysis of the High-STEACS Trial

Session Information

• CKD: Clinical, Outcomes, Trials - III
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Author

• Gallacher, Peter J., University of Edinburgh, Edinburgh, United Kingdom

Peter J. Gallacher,

Group or Team Name

• High-STEACS Investigators

Background

Patients with renal impairment are at increased risk of myocardial infarction (MI), but the interpretation of cardiac troponin in this context is challenging. Using a high-sensitivity cardiac troponin I (hs-cTnI) assay that has been widely adopted into clinical practice, we describe the diagnosis and outcomes of patients with MI, stratified by renal function.

Methods

In a pre-specified secondary analysis of a stepped-wedge cluster-randomised controlled trial, consecutive patients with suspected acute coronary syndrome (ACS), a hs-cTnI concentration greater than the sex-specific 99^th centile and renal impairment (defined as an estimated glomerular filtration rate [eGFR] of <60 mL/min/1.73m²) were identified between June 2013 and March 2016. Diagnoses of type 1 or type 2 MI were adjudicated and classified according to the 4^th Universal Definition of Myocardial Infarction. The primary outcome of type 1 MI or cardiovascular death was compared in patients with and without renal impairment at 1 year.

Results

eGFR was available in 46,927 (97.1%) patients. 38,994 (83.1%) patients had an eGFR ≥60, 6,627 (14.1%) had an eGFR 30-59 and 1,306 (2.8%) had an eGFR <30. Plasma hs-cTnI concentrations were raised in 47.9% of patients with and 16.2% without renal impairment.

Patients with renal impairment were less likely to be diagnosed with type 1 MI (35.2% [1,336/3,800] vs 56.3% [3,556/6,311]) but more likely to be diagnosed with type 2 MI (12.6% [480/3,800] vs 9.8% [619/6,311]; P<0.001 for both) than patients with normal renal function.

In patients with hs-cTnI concentrations >99^th centile, the risk of subsequent MI or cardiovascular death at 1 year was significantly increased in patients with renal impairment compared to those without it (24.9% [945/3,800] vs 12.0% [757/6,311]; adjusted hazard ratio [aHR] 1.56, 95% CI 1.34 to 1.82; P<0.001). This risk increased as eGFR declined: 30-59 mL/min/1.73m² (23.2% [674/2,905]; aHR 1.51, 95% CI 1.28-1.78); <30 mL/min/1.73m² (30.3% [271/895]; aHR 1.74, 95% CI 1.39-2.19) (P<0.001 for both).

Conclusion

Almost half of all patients with suspected ACS and renal impairment had a hs-cTnI greater than the sex-specific 99^th centile. This was associated with a poorer prognosis, especially in those with an eGFR <30mL/min/1.73m².