Can serum troponin be used in the diagnosis of myocardial infarction in patients with kidney disease?
The use of biomarkers for the diagnosis of myocardial infarction in patients with CKD can be problematic. Serum troponin has been found to be elevated in patients with CKD who have no clinical suspicion of acute myocardial injury. It is not absolutely clear why this is the case.
This may have to do with subclinical myocardial ischemia or decreased clearance of troponin degradation products because of kidney disease.
Baseline elevations in troponin are associated with the higher risk of cardiovascular death in these patients. Troponin I is a more specific marker of infarction that troponin T in these patients.
Even so, whether or not an elevation in serum troponin in a given patient indicates acute myocardial injury, it is necessary to take into account the patient’s clinical presentation and change in the blood levels of troponin over time.
For example, a rising troponin level in a patient who presents with typical chest pain would be consistent with the diagnosis of acute myocardial infarction.
On the other hand, small and unchanging elevations in an otherwise asymptomatic patient would portend a poor long-term prognosis but are unlikely to be of any immediate import.
