Abstract 15914: Cardiac Troponin I versus T for Revascularization and Survival in Non-ST Elevation Acute Coronary Syndrome in Patients With Chronic Kidney Disease

Introduction/Background Cardiac troponins (cTn) underlie the diagnosis of non-ST elevation (NSTE)- acute coronary syndrome (ACS). Utility of specific cTn types is less delineated for patients with chronic kidney disease (CKD). Goals/Aims Determine the predictive value of two cardiac enzymes-cTnI and cTnT- for revascularization procedures (percutaneous coronary intervention [PCI]/coronary artery bypass grafting [CABG]) and mortality.

Methods/Approach Patients with CKD (estimated glomerular filtration rate &lt 60mL/min/1.73m2) admitted with a diagnosis of NSTE-ACS within the Veterans Affair Healthcare System between 1999 and 2022 (n=56711). Proportional change of serial cTnI and cTnT was calculated. Outcomes included PCI and CABG, and inpatient and 12 months after hospitalization mortality. Classifier ability is quantified by comparison of area under receiver operating characteristic (AUROC) for proportional change in cTnI or cTnT; hypothesis testing is completed with empirical AUC, Mann-Whitney U testing.

Results/Data Proportional change in serial cTnT was not found to be statistically different compared to cTnI in predicting revascularization (AUROC 0.524 vs 0.512; p = 0.423). Proportional cTnT change had statistically higher predictive ability compared to cTnI for inpatient mortality (AUROC 0.584 vs 0.500; p = 0.007) and 12-month mortality (AUROC 0.550 vs 0.515; p = 0.038) (Figure).

Conclusion In CKD patients with NSTE-ACS, cTnT demonstrated higher predictive ability in the prognostication of short- and long-term outcomes. Prospective studies are needed to further characterize optimal cTn assay type in patients with kidney disease presenting with symptoms concerning for ACS.