{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:13:16Z","timestamp":1793236396228,"version":"4.5.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,10,2]]},"abstract":"\n Background<\/jats:title>\n \n Patients with chronic kidney disease (\n CKD<\/jats:styled-content>\n ) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction (\n AMI<\/jats:styled-content>\n ) without\n ST<\/jats:styled-content>\n \u2010segment elevation (\n NSTE<\/jats:styled-content>\n ). In patients with\n CKD<\/jats:styled-content>\n , troponin levels are often chronically elevated, which reduces their diagnostic utility when\n NSTE<\/jats:styled-content>\n \u2010\n AMI<\/jats:styled-content>\n is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with\n CKD<\/jats:styled-content>\n and suspected\n NSTE<\/jats:styled-content>\n \u2010\n AMI<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Two cohorts, 1494 patients from a prospective cohort study with high\u2010sensitivity troponin I (hs\u2010\n cTnI<\/jats:styled-content>\n ) measurements and 7059 cases from a clinical registry with high\u2010sensitivity troponin T (hs\u2010\n cTnT<\/jats:styled-content>\n ) measurements, were analyzed. The prospective cohort comprised 280\n CKD<\/jats:styled-content>\n patients (estimated glomerular filtration rate <60\u00a0mL\/min\/1.73\u00a0m\n 2<\/jats:sup>\n ). The registry data set contained 1581\n CKD<\/jats:styled-content>\n patients. In both cohorts,\n CKD<\/jats:styled-content>\n patients were more likely to have adjudicated\n NSTE<\/jats:styled-content>\n \u2010\n AMI<\/jats:styled-content>\n than non\u2010\n CKD<\/jats:styled-content>\n patients. The specificities of hs\u2010\n cTnI<\/jats:styled-content>\n and hs\u2010\n cTnT<\/jats:styled-content>\n to detect\n NSTE<\/jats:styled-content>\n \u2010\n AMI<\/jats:styled-content>\n were reduced with\n CKD<\/jats:styled-content>\n (0.82 versus 0.91 for hs\u2010\n cTnI<\/jats:styled-content>\n and 0.26 versus 0.73 for hs\u2010\n cTnT<\/jats:styled-content>\n ) but could be restored by applying optimized cutoffs to either the first or a second measurement after 3\u00a0hours. The best diagnostic performance was achieved with an algorithm that incorporates serial measurements and rules in or out\n AMI<\/jats:styled-content>\n in 69% (hs\u2010\n cTnI<\/jats:styled-content>\n ) and 55% (hs\u2010\n cTnT<\/jats:styled-content>\n ) of CKD patients.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The diagnostic performance of high\u2010sensitivity cardiac troponins in patients with\n CKD<\/jats:styled-content>\n with suspected\n NSTE<\/jats:styled-content>\n \u2010\n AMI<\/jats:styled-content>\n is improved by use of an algorithm based on admission troponin and dynamic changes in troponin concentration.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.008032","type":"journal-article","created":{"date-parts":[[2018,9,25]],"date-time":"2018-09-25T09:00:41Z","timestamp":1537866041000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Cardiac Troponins for the Diagnosis of Acute Myocardial Infarction in Chronic Kidney Disease"],"prefix":"10.1161","volume":"7","author":[{"given":"Daniel","family":"Kraus","sequence":"first","affiliation":[{"name":"Division of Nephrology 1st Department of Medicine University of W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"von Jeinsen","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), partner site RheinMain Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stergios","family":"Tzikas","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology \u0399ppokrateio Hospital Aristotle University of Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Palapies","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Zeller","sequence":"additional","affiliation":[{"name":"Clinic for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), partner site Hamburg\/L\u00fcbeck\/Kiel Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Bickel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Federal Armed Forces Hospital Koblenz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Fette","sequence":"additional","affiliation":[{"name":"Department for Artificial Intelligence and Applied Computer Science University of W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl J.","family":"Lackner","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine University Medical Center Johannes Gutenberg University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Drechsler","sequence":"additional","affiliation":[{"name":"Division of Nephrology 1st Department of Medicine University of W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes T.","family":"Neumann","sequence":"additional","affiliation":[{"name":"Clinic for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), partner site Hamburg\/L\u00fcbeck\/Kiel Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Baldus","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III University of Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[{"name":"Clinic for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), partner site Hamburg\/L\u00fcbeck\/Kiel Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II University Medical Center Johannes Gutenberg University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Wanner","sequence":"additional","affiliation":[{"name":"Division of Nephrology 1st Department of Medicine University of W\u00fcrzburg Germany"},{"name":"Comprehensive Heart Failure Center (CHFC) University Hospital W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas M.","family":"Zeiher","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), partner site RheinMain Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Keller","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), partner site RheinMain Frankfurt Germany"},{"name":"Department of Cardiology Kerckhoff Heart and Thorax Center Bad Nauheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp014"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.014245"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.02.024"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0903515"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1896"},{"key":"e_1_3_2_8_2","unstructured":"Fette G Ertl M W\u00f6rner A Kl\u00fcgl P St\u00f6rk S Puppe F. Information extraction from unstructured electronic health records and integration into a data warehouse. In: Goltz U Magnor MA Appelrath H\u2010J Matthies HK Balke W\u2010T Wolf LC eds. Informatik 2012. GI: Braunschweig Germany; 2012:1237\u20131251. Available at: https:\/\/subs.emis.de\/LNI\/Proceedings\/Proceedings208\/P-208.pdf."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.06.026"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2009.008197"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.08.006"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2007.095679"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5000174"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.140616"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1159\/000458451"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2005.01.006"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep41350"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr236"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2010.146639"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2008.114728"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.134460"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.08.028"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.117.008032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:17:18Z","timestamp":1715599038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.117.008032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,2]]},"references-count":22,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2018,10,2]]}},"alternative-id":["10.1161\/JAHA.117.008032"],"URL":"https:\/\/doi.org\/10.1161\/jaha.117.008032","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,2]]},"assertion":[{"value":"2017-11-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e008032"}}