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Troponina cardíaca de alta sensibilidad y estratificación del riesgo en pacientes con insuficiencia renal con

Eve Miller-Hodges1,2, Atul Anand1, Anoop S V Shah1

  • 1University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.).

Circulation
|October 6, 2017
PubMed
Resumen

La prueba de troponina I cardíaca de alta sensibilidad ayuda al diagnóstico del infarto de miocardio, pero requiere una interpretación cuidadosa en pacientes con insuficiencia renal. Las personas con insuficiencia renal y troponina elevada enfrentan un riesgo duplicado de eventos cardíacos importantes.

Palabras clave:
Síndrome coronario agudoInfarto de miocardioInsuficiencia renalel riesgoLa troponina también

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Área de la Ciencia:

  • Cardiología
  • Medicina del riñón
  • Análisis de biomarcadores

Sus antecedentes:

  • Los ensayos de troponina cardíaca de alta sensibilidad (hs-cTn) son cruciales para el diagnóstico del infarto de miocardio (IM).
  • La interpretación de las concentraciones de hs-cTn es difícil en pacientes con insuficiencia renal.
  • La utilidad diagnóstica y pronóstica del hs-cTn en la insuficiencia renal sigue siendo incierta.

Objetivo del estudio:

  • Evaluar el rendimiento de hs-cTn I en pacientes con y sin insuficiencia renal.
  • Evaluar la precisión del diagnóstico y las capacidades de estratificación del riesgo del hs-cTn I en casos de sospecha de síndrome coronario agudo (SAC).
  • Determinar el valor pronóstico de hs-cTn I en pacientes con insuficiencia renal.

Principales métodos:

  • Estudio prospectivo multicéntrico de pacientes consecutivos con sospecha de SCA.
  • Evaluación del rendimiento de hs-cTn I en pacientes con y sin insuficiencia renal (eGFR < 60 ml/ min/ 1,73 m2).
  • Evaluación del valor predictivo negativo (VNP), la sensibilidad, el valor predictivo positivo (VPP) y la especificidad en diferentes umbrales para el infarto de miocardio de tipo 1 y los eventos cardíacos adversos mayores (MACE) a los 30 días y 1 año.

Principales resultados:

  • El 19% de los 4. 726 pacientes tenían insuficiencia renal.
  • hs-cTn I < 5 ng/ l identificó un menor número de pacientes con insuficiencia renal como de bajo riesgo (17%) en comparación con los que no la tenían (56%), con un VAN y sensibilidad similares.
  • Se observó una menor VPP y especificidad en el umbral del percentil 99 en pacientes con insuficiencia renal en comparación con aquellos sin ella. Los pacientes con insuficiencia renal y hs-cTn I elevado tenían un riesgo 2 veces mayor de MACE a 1 año.

Conclusiones:

  • hs-cTn I identifica un menor número de pacientes de bajo riesgo y un mayor número de pacientes de alto riesgo con insuficiencia renal, aunque con una especificidad reducida para el infarto de miocardio tipo 1.
  • Las concentraciones elevadas de hs-cTn I en pacientes con insuficiencia renal indican un riesgo significativamente mayor de eventos cardíacos importantes.
  • Los pacientes con insuficiencia renal y hs-cTn I elevado requieren más investigación y estrategias de tratamiento adaptadas.