Aim: To evaluate the diagnostic efficiency of cardiac troponin (cTn) for acute myocardial infarction in renal insufficiency patients. Materials & methods: Medline, EMBASE and the CENTRAL databases were searched for eligible studies. Results: Thirteen studies were included. The sensitivity of the 99th percentiles for high-sensitivity cTn (hs-cTn) was 0.94 (95% CI: 0.87, 0.97), the specificity was 0.56 (95% CI: 0.42, 0.68). Subgroup analysis found that the sensitivity for hs-cTnT and hs-cTnI were similar, but the specificity was higher for hs-cTnI. The optimized cut-off values slightly increased the specificity, but decreased the sensitivity. Serial sampling of hs-cTn seemed to increase the diagnostic efficiency. Conclusion: The usual and optimized cut-off threshold for cTn had decreased diagnostic efficacy for acute myocardial infarction. Serial sampling seemed to increase the diagnostic efficiency.
Keywords: acute myocardial infarction; cardiac troponin; renal insufficiency; sensitivity and specificity.