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High-sensitivity cardiac troponin I (hs-cTnI) assays are increasingly used to detect myocardial injury, but in patients with renal impairment, troponin values are often elevated, complicating their interpretation.
In this cluster-randomized trial, researchers evaluated use of an hs-cTnI assay in patients with suspected acute coronary syndromes at 10 hospitals that were randomized to early or late use of the assay. Hs-cTnI concentrations were increased above the sex-specific 99th percentile in 22% of the nearly 47,000 patients studied. Forty-two percent of those with elevations had kidney impairment, as defined by an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2.
Elevated troponin levels became more common as eGFR declined,…