Interpreting cardiac troponin results from highly sensitive assays in patients with chronic kidney disease: acute coronary syndromes and beyond.
Cardiac troponin assays have become an indispensable tool in the diagnosis of acute myocardial infarction (MI). However, asymptomatic patients with chronic kidney disease often exhibit elevated levels of cardiac troponins with near ubiquitous detection using the new high-sensitive assays. This poses a challenge to physicians faced with differentiating between acute MI and a noncardiac etiology of chest pain or equivalent. Rather than rely on absolute cutoffs it is necessary to follow trends in levels at least over several hours. Even in the absence of an acute MI there is an association between chronic elevations of these biomarkers, underlying structural heart disease and poor prognosis. Although in the chronic setting the underlying cause of cardiac troponin elevation is likely a combination of factors, it should prompt further investigation for modifiable risk factors.