Prognostic significance of elevated baseline troponin in patients with acute coronary syndromes and chronic kidney disease treated with different antithrombotic regimens: a substudy from the ACUITY trial

Circulation. Cardiovascular Interventions
Subasit AcharjiGregg W Stone

Abstract

Elevation of baseline cardiac troponin in patients presenting with acute coronary syndromes (ACS) confers an adverse prognosis. The prognostic value of troponin elevation in patients with chronic kidney disease (CKD) and ACS is less certain. In the ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) trial, 13 819 patients with moderate and high-risk ACS were assigned randomly to receive heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin monotherapy. Among 2179 patients with CKD (creatinine clearance <60 mL/min), baseline troponin elevation was present in 1291 patients (59.2%). Major bleeding and major adverse cardiac events (MACE), including death, myocardial infarction (MI), or unplanned revascularization, were examined according to baseline troponin status and randomization arm. Patients with CKD in whom the baseline troponin level was elevated had significantly higher rates of death, MI, and MACE at 30 days and 1 year compared with CKD patients without elevated baseline troponin. By multivariable analysis, baseline troponin elevation in patients with CKD was an independent predictor of composite death or MI at 30 days (hazard ratio [95% CI]=2.05 [1.48, 2.83], P<0.0...Continue Reading

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Citations

Apr 16, 2014·International Journal of Nephrology·Baris AfsarMehmet Kanbay
Jul 27, 2014·Clinical Chemistry·Charlotte Ebeling BarbierHåkan Ahlström
Dec 14, 2019·The American Journal of Emergency Medicine·Brit LongJonathan M Bronner
Jul 23, 2021·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Nisha BansalUNKNOWN CRIC Study Investigators

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