3485 IMPROVING THE DIAGNOSIS OF MYOCARDIAL INFARCTION IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Chronic Kidney Disease has significant morbidity and mortality owing to the increased prevalence in cardiovascular disease. This increase in morbidity and mortality is seen more so as glomerular filtration rate (GFR) declines, that is, advanced kidney failure with GFR equal to or less than 30ml/min/1.73m2. Hence, it is important to control risk factors and accurately diagnose myocardial infarction in this cohort of patients. Secondary objectives showed that social isolation was significantly associated with confirmed myocardial infarction. Additionally, ST changes, and T- QRS discordance on electrocardiogram were found more commonly in the myocardial infarction group. Other diagnostic tools such as angiography proved to be an underutilized investigation with a prevalence of 13% in the kidney disease cohort at the University of the West Indies during the years 2018 to 2020. Method In this retrospective cross-sectional study, data was collected from the online records system at the University of the West Indies. Patients with an admission diagnosis of acute coronary syndrome, unstable angina, non-ST elevation myocardial infarction, ST elevation myocardial infarction and chronic kidney disease were included in the study population. Cases were assigned based on whether or not myocardial infarction was confirmed on echocardiogram. Results Of the total number of 102 cases, 58 were chosen based on fulfillment of our inclusion criteria. 13 (22.4%) had echocardiographic evidence of a new myocardial infarction while 44 (75.9%) had no echocardiographic evidence of new myocardial infarction. Receiver Operator Characteristic Curves (ROC) used to evaluate the diagnostic performance of high sensitivity cardiac troponin T and interval/ delta changes showed an ideal value 141.50ng/L on first troponin T and 100.75ng/L on serial troponin T with delta change of 20.5%, (sensitivities of 61.5%, 72.7% and 72.7% respectively). Area under the Receiver-Operating Characteristic Curve (AUC) used to determine the diagnostic accuracy of the highly sensitivity cardiac troponin T and interval delta change demonstrated high accuracy of 0.708 for the first troponin T, 0.750 for the second troponin T and 0.767 for the interval or delta change. Conclusion Overall, we showed that serial troponin measurements in kidney disease patients increase sensitivity for predicting myocardial infarction and that the values are nearly 10 times that used for the general populat