J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 13, Number 6, June 2021, pages 326-333

High-Sensitivity Troponin for Suspected Acute Coronary Syndrome in Patients With Chronic Kidney Disease Versus Patients Without Chronic Kidney Disease

Figure 1. Comparison of sensitivities, specificities, positive predictive values and negative predictive values of delta hs-cTnT > 5 for acute coronary syndrome and coronary artery disease in patients with and without chronic kidney disease. CKD: chronic kidney disease; PPV: positive predictive value; NPV: negative predictive value; hs-cTnT: high-sensitivity cardiac troponin-T.

Figure 2. Comparison of sensitivities, specificities, positive predictive values and negative predictive values of delta hs-cTnT > 5 for acute coronary syndrome and coronary artery disease requiring coronary stents in patients with and without chronic kidney disease. CKD: chronic kidney disease; PPV: positive predictive value; NPV: negative predictive value; hs-cTnT: high-sensitivity cardiac troponin-T.

**Table 1.** Baseline Characteristics, Comorbidities and Medications
Variables	Patients with CKD (n = 29)	Patients without CKD (n = 60)	P
CKD: chronic kidney disease; SD: standard deviation; BP: blood pressure; BMI: body mass index; hs-cTnT: high-sensitivity cardiac troponin-T (0 h value); WBC: white blood cell; LDL: low-density lipoprotein; HDL: high-density lipoprotein; TG: triglycerides; eGFR: estimated glomerular filtration rate; CAD: coronary artery disease; CVA: cerebrovascular accident; CHF: congestive heart failure; CCB: calcium channel blocker; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; BB: beta-blocker.
Age (years), mean (SD)	61.2 (14.8)	58.9 (15.6)	0.508
Gender			0.545
Male, n (%)	16 (55.2)	29 (48.3)
Female, n (%)	13 (44.8)	31 (51.7)
Race			0.289
White, n (%)	13 (44.8)	36 (60.0)
Black, n (%)	10 (34.5)	12 (20.0)
Hispanic, n (%)	6 (20.7)	12 (20.0)
Social
Tobacco use, n (%)	10 (34.5)	26 (44.1)	0.460
Alcohol use, n (%)	6 (20.7)	16 (27.1)	0.568
Vitals
Systolic BP (mm Hg), mean (SD)	135 (24.9)	125 (19.5)	0.047
Diastolic BP (mm Hg), mean (SD)	77 (16.0)	73 (13.3)	0.274
BMI (kg/m²)	33.4 (8.5)	30.7 (9.7)	0.280
Lab values
hs-cTnT (ng/L), mean (SD)	538.62 (1,939.01)	216.65 (803.40)	0.277
Delta hs-cTnT > 5 (ng/L), n (%)	17 (63.0)	22 (37.3)	0.026
WBC (10³/µL), mean (SD)	8.4 (3.9)	10.3 (15.6)	0.525
Total cholesterol (mg/dL), mean (SD)	142.9 (42.7)	165.9 (73.9)	0.139
LDL (mg/dL), mean (SD)	74.2 (30.2)	89.4 (46.6)	0.127
HDL (mg/dL), mean (SD)	45.5 (18.7)	43.0 (17.1)	0.550
TG (mg/dL), mean (SD)	125.0 (49.8)	156.3 (112.7)	0.088
eGFR (mL/min/1.73 m²), mean (SD)	35.1 (20.1)	69.5 (2.7)	< 0.001
Comorbidities
Hypertension, n (%)	26 (92.9)	42 (70.0)	0.017
Diabetes mellitus, n (%)	17 (60.7)	20 (33.3)	0.015
Hyperlipidemia, n (%)	19 (67.9)	28 (46.7)	0.063
CAD, n (%)	21 (72.4)	32 (53.3)	0.086
CVA, n (%)	5 (17.9)	6 (10.0)	0.316
CHF, n (%)	14 (50.0)	17 (28.3)	0.047
Medications
Aspirin, n (%)	17 (60.0)	32 (53.3)	0.569
Statin, n (%)	18 (64.3)	36 (60.0)	0.701
CCB, n (%)	9 (32.1)	9 (15.0)	0.063
ACE-I, n (%)	6 (21.4)	23 (38.3)	0.116
ARB, n (%)	5 (17.9)	10 (16.7)	1.000
Diuretic, n (%)	18 (64.3)	22 (36.7)	0.015
BB, n (%)	25 (89.3)	37 (61.7)	0.008
Anticoagulant, n (%)	7 (25.0)	16 (26.7)	0.868

Table 1. Baseline Characteristics, Comorbidities and Medications

Variables

Patients with CKD (n = 29)

Patients without CKD (n = 60)

CKD: chronic kidney disease; SD: standard deviation; BP: blood pressure; BMI: body mass index; hs-cTnT: high-sensitivity cardiac troponin-T (0 h value); WBC: white blood cell; LDL: low-density lipoprotein; HDL: high-density lipoprotein; TG: triglycerides; eGFR: estimated glomerular filtration rate; CAD: coronary artery disease; CVA: cerebrovascular accident; CHF: congestive heart failure; CCB: calcium channel blocker; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; BB: beta-blocker.

Age (years), mean (SD)

61.2 (14.8)

58.9 (15.6)

0.508

Gender

0.545

Male, n (%)

16 (55.2)

29 (48.3)

Female, n (%)

13 (44.8)

31 (51.7)

Race

0.289

White, n (%)

13 (44.8)

36 (60.0)

Black, n (%)

10 (34.5)

12 (20.0)

Hispanic, n (%)

6 (20.7)

12 (20.0)

Social

Tobacco use, n (%)

10 (34.5)

26 (44.1)

0.460

Alcohol use, n (%)

6 (20.7)

16 (27.1)

0.568

Vitals

Systolic BP (mm Hg), mean (SD)

135 (24.9)

125 (19.5)

0.047

Diastolic BP (mm Hg), mean (SD)

77 (16.0)

73 (13.3)

0.274

BMI (kg/m²)

33.4 (8.5)

30.7 (9.7)

0.280

Lab values

hs-cTnT (ng/L), mean (SD)

538.62 (1,939.01)

216.65 (803.40)

0.277

Delta hs-cTnT > 5 (ng/L), n (%)

17 (63.0)

22 (37.3)

0.026

WBC (10³/µL), mean (SD)

8.4 (3.9)

10.3 (15.6)

0.525

Total cholesterol (mg/dL), mean (SD)

142.9 (42.7)

165.9 (73.9)

0.139

LDL (mg/dL), mean (SD)

74.2 (30.2)

89.4 (46.6)

0.127

HDL (mg/dL), mean (SD)

45.5 (18.7)

43.0 (17.1)

0.550

TG (mg/dL), mean (SD)

125.0 (49.8)

156.3 (112.7)

0.088

eGFR (mL/min/1.73 m²), mean (SD)

35.1 (20.1)

69.5 (2.7)

< 0.001

Comorbidities

Hypertension, n (%)

26 (92.9)

42 (70.0)

0.017

Diabetes mellitus, n (%)

17 (60.7)

20 (33.3)

0.015

Hyperlipidemia, n (%)

19 (67.9)

28 (46.7)

0.063

CAD, n (%)

21 (72.4)

32 (53.3)

0.086

CVA, n (%)

5 (17.9)

6 (10.0)

0.316

CHF, n (%)

14 (50.0)

17 (28.3)

0.047

Medications

Aspirin, n (%)

17 (60.0)

32 (53.3)

0.569

Statin, n (%)

18 (64.3)

36 (60.0)

0.701

CCB, n (%)

9 (32.1)

9 (15.0)

0.063

ACE-I, n (%)

6 (21.4)

23 (38.3)

0.116

ARB, n (%)

5 (17.9)

10 (16.7)

1.000

Diuretic, n (%)

18 (64.3)

22 (36.7)

0.015

BB, n (%)

25 (89.3)

37 (61.7)

0.008

Anticoagulant, n (%)

7 (25.0)

16 (26.7)

0.868

**Table 2.** Influence of Risk Factors on Delta hs-cTnT > 5
Risk factor	B	P	Exp(B)	95% CI for Exp(B)
hs-cTnT: high-sensitivity cardiac troponin-T; CI: confidence interval; CAD: coronary artery disease; CVA: cerebrovascular accident; CHF: congestive heart failure; CKD: chronic kidney disease.
Age (years)	0.040	0.088	1.041	0.994	1.090
Sex male	0.802	0.188	2.230	0.675	7.369
White vs. Black	1.544	0.033	4.683	1.134	19.339
White vs. Hispanic	0.558	0.433	1.747	0.434	7.038
Tobacco use	0.741	0.241	2.098	0.607	7.249
Alcohol use	-0.487	0.469	0.615	0.164	2.298
Hypertension	1.991	0.047	7.323	1.031	52.037
Diabetes mellitus	-0.258	0.662	0.773	0.243	2.456
Hyperlipidemia	-0.513	0.436	0.599	0.165	2.175
CAD	0.855	0.213	2.351	0.612	9.030
CVA	0.329	0.708	1.390	0.248	7.793
CHF	0.242	0.693	1.273	0.384	4.219
CKD	0.633	0.297	1.884	0.573	6.197

Table 2. Influence of Risk Factors on Delta hs-cTnT > 5

Risk factor

Exp(B)

95% CI for Exp(B)

Lower

Upper

hs-cTnT: high-sensitivity cardiac troponin-T; CI: confidence interval; CAD: coronary artery disease; CVA: cerebrovascular accident; CHF: congestive heart failure; CKD: chronic kidney disease.

Age (years)

0.040

0.088

1.041

0.994

1.090

Sex male

0.802

0.188

2.230

0.675

7.369

White vs. Black

1.544

0.033

4.683

1.134

19.339

White vs. Hispanic

0.558

0.433

1.747

0.434

7.038

Tobacco use

0.741

0.241

2.098

0.607

7.249

Alcohol use

-0.487

0.469

0.615

0.164

2.298

Hypertension

1.991

0.047

7.323

1.031

52.037

Diabetes mellitus

-0.258

0.662

0.773

0.243

2.456

Hyperlipidemia

-0.513

0.436

0.599

0.165

2.175

CAD

0.855

0.213

2.351

0.612

9.030

CVA

0.329

0.708

1.390

0.248

7.793

CHF

0.242

0.693

1.273

0.384

4.219

CKD

0.633

0.297

1.884

0.573

6.197