Improving the diagnostic performance of troponin assays for acute myocardial infarction in renal impairment

Background Serum troponin measurement forms a cornerstone of acute myocardial infarction (AMI) diagnosis. A major challenge is interpretation of an elevated first troponin in patients with impaired renal function. We aimed to (1) evaluate the relationship between estimated glomerular filtration rate (eGFR) and first troponin, (2) characterise the performance of different troponin assays for diagnosing AMI and (3) derive eGFR-specific thresholds for potential clinical use. Methods We analysed the distribution of troponin values stratified by eGFR and AMI. Diagnostic performance was analysed using the C-statistic. Test detection rate, false positive rate and positive predictive value were calculated for different cut-offs. Results We included 221 175 patients between 2010 and 2017 from four acute tertiary care hospitals in London, UK, with a median age of 65 years (IQR 49–79). eGFR was90 (C-statistic 0.93) and worst in eGFR