Value of Highly Sensitive Troponin T for Diagnosis of Acute Coronary Syndrome in Chronic Kidney Disease Patients

Background: Chronic kidney disease (CKD) is a common disease in clinical practice and increases the risk for acute coronary syndrome, and there are little data about the relation between the elevation of troponin T levels and morbidity and mortality outcomes in CKD patients. The aim of the work: is to estimate the appropriate highly-sensitive troponin T average value in CKD patients who presented with acute coronary syndrome and its relation to the outcome. Patients and methods: The study included 60 patients who were sub-divided into two groups, First group: 30 patients with CKD and ACS as the study group, the second group: 30 patients with ACS without evidence of CKD as the control group. Measurement of the highly sensitive troponin T level after 1-3 hours of the onset of chest pain and calculation of the estimated glomerular filtration rate (eGFR) was done. Results: The mean levels of the highly sensitive troponin T levels were significantly higher in patients with CKD and ACS with p value less than 0.05 and there was significant statistical difference between mean of HS Trop T of patients with ACS and complications and those without (4.3 ± 1.1 vs. 2.1± 0.9 ng/ml; P= 0.03). Also, mean of HS Trop T of patients with ACS that were died was significantly higher than those were improved (2.91± 0.6 vs. 3.1 ± 0.9; P = 0.02) Conclusion: There is a direct negative correlation between the levels of highly sensitive troponin T and estimated glomerular filtration rate, but there is a direct relation between the higher level of highly sensitive troponin T and mortality and morbidity rates in patients with ACS and CKD. The specificity of the highly sensitive troponin T decreases with the decreased estimated GFR in ACS and CKD patients resulting in higher level of highly sensitive troponin T required for the diagnosis of NSTE-ACS.