Outcomes in patients admitted for chest pain with renal failure and troponin I elevations

Kontos, Michael C.; Garg, Rajat; Anderson, F. Philip; Tatum, James L.; Ornato, Joseph P.; Jesse, Robert L.

doi:10.1016/j.ahj.2004.11.008

« Previous Next »American Heart Journal
Volume 150, Issue 4 , Pages 674-680, October 2005

Outcomes in patients admitted for chest pain with renal failure and troponin I elevations

Presented in part in Orlando, Fla, at the Sessions of the American Heart Association Scientific Meetings, November 2003.

Michael C. Kontos, MD
- Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University, Richmond, Va
- Department Emergency Medicine, Virginia Commonwealth University, Richmond, Va
- Department Radiology, Virginia Commonwealth University, Richmond, Va
- Reprint requests: Michael C. Kontos, MD, Room 7-074, Heart Station, North Hospital, PO Box 980051, Medical College of Virginia, 12th and Marshall Sts, Richmond, VA 23298-0051.
Rajat Garg, MD
- Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University, Richmond, Va
F. Philip Anderson, PhD
- Department Pathology, Clinical Chemistry Division, Virginia Commonwealth University, Richmond, Va
James L. Tatum, MD
- Department Radiology, Virginia Commonwealth University, Richmond, Va
Joseph P. Ornato, MD
- Department Emergency Medicine, Virginia Commonwealth University, Richmond, Va
Robert L. Jesse, MD, PhD
- Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University, Richmond, Va

Received 10 May 2004; accepted 21 November 2004.

Background

The significance of troponin I (TnI) elevations in patients with renal failure (RF) admitted for possible myocardial ischemia is unclear. We therefore compared outcomes in patients with and without TnI elevations based on renal function.

Methods

Consecutive patients without ST elevation admitted for exclusion of ischemia underwent serial assessment of cardiac markers including TnI. Coronary angiography, significant disease, and revascularization were determined, and 1-year cardiac mortality and all-cause mortality were assessed. Mortality was assessed based on TnI elevations in patients with no (creatinine clearance [CrCl] ≥60 mL/min), moderate (CrCl 30-59 mL/min), and severe (CrCl <30 mL/min) RF.

Results

Troponin I elevations were present in 17% of the 3774 consecutive patients and were significantly more frequent in patients with RF (CrCl <30 mL/min: 26%; CrCl 30-59 mL/min: 19%; CrCl >60 mL/min: 13%, all P ≤ .01). Coronary angiography was performed significantly less frequently in patients with RF, whether TnI elevations were present. One-year all-cause mortality increased with both RF and TnI positivity (TnI [+] vs TnI [−], CrCl <30 mL/min: 52% vs 26%; CrCl 30-59 mL/min: 21% vs 14%; CrCl >60 mL/min: 8.9% vs 4.9%, all P < .001) . Troponin I was the most important independent predictor of mortality in the 3 RF groups (odds ratio 3.3 for CrCl <30 mL/min, 2.2 for CrCl 30-59 mL/min, and 3.3 for CrCl >60 mL/min).