ArticleCJEM2026
Enhancing the accuracy of high-sensitivity troponin for diagnosing acute myocardial infarction in emergency department patients with kidney dysfunction: a scoping review.
Article in CJEM, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo systematically identify and describe optimal methodology used to improve the diagnostic accuracy of high-sensitivity cardiac troponin for diagnosis of myocardial infarction in patients with kidney dysfunction.
methodsCochrane, MEDLINE, EMBASE, and Google Scholar were systematically searched for studies describing strategies to increase the diagnostic accuracy of high-sensitivity cardiac troponin testing in emergency department patients with kidney dysfunction and suspected myocardial infarction. Study eligibility ascertainment and data extraction was performed by two independent reviewers. Findings of included studies were summarized and categorized according to methodological approach for improving diagnostic accuracy.
resultsData extraction was organized using Covidence online software. A total of 946 papers were identified in the electronic search. Of these, 878 were excluded based on review of titles and abstracts, 59 were removed after full-text review, and 9 studies were included in the final synthesis. Most studies identified alternative diagnostic troponin concentrations while one adjusted for kidney function using a multivariable model. Optimal cutoff concentrations for single and serial troponin samples varied by glomerular filtration rate and across published studies. Multivariable adjustment did not improve diagnostic accuracy of troponin testing, and glomerular filtration rate was not a significant covariate suggesting that kidney function acts as an effect measure modifier rather than as a confounder.
conclusionDiagnosing myocardial infarction is particularly challenging in individuals with kidney dysfunction. High initial concentrations and serial changes seem specific for ruling in myocardial infarction, while low initial concentrations and minimal serial changes appear to safely rule out myocardial infarction. However, no strategy has been externally validated for widespread adoption. Further work should focus on identifying diagnostic strategies that use kidney function as an effect measure modifier, and that can be externally validated.
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