Evaluation of Troponin I Values in Acute Coronary Syndrome Patients with and Without Impaired Renal Function

Abstract

Background & Objective: Elevated cardiac troponin levels are common in chronic kidney disease (CKD) which make it
challenging to diagnose acute coronary syndrome in these patients. It is difficult to interpret the cardiac troponin
levels in CKD patients due to persistent increase of troponin levels in these patients which limit their diagnostic value.
Our study aims to evaluate troponin-I levels in patients with acute coronary syndrome with and without impaired renal
function
Methodology: Retrospective Cross-sectional study conducted in Pathology department, Shalamar Hospital Laboratory,
Lahore from February 2025 to August 2025. A total of 202 Patients aged between 25 to 65 years both genders diagnosed
as acute coronary syndrome with evaluated renal function were included. Data was divided in two groups i.e., Group A
(Preserved renalfunction, eGFR≥60ml/min/1.73m2) Group B (Impaired renalfunction, eGFR<60ml/min/1.73m2). Troponin I
levels were compared between patients with and without impaired renal function and p value <0.05 taken as
statistically significant.
Results: Median age was 42 years in patients with preserved renal function and 53 years in patients with impaired renal
function. Troponin I levels were significantly higher in patients with impaired renal function (6.80ng/ml) than in patients
with preserved renal function (3.80ng/ml). Weak negative, statistically insignificant correlation found between eGFR
and troponin I (r, p value: -0.18, 0.09) in patients with preserved renal function (Group A). Moderate to strong,
significant negative correlation between eGFR and troponin I (r, p value: -0.56, <0.001) in patients with impaired renal
function (Group B). Statistically significant difference in troponin I levels between patients with preserved and
impaired renal function with higher levels in impaired group with P value 0.012.
Conclusion: It has been concluded that serum troponin I levels are significantly higher in patients with acute coronary
syndrome with impaired renal function. These findings highlight the importance of interpreting troponin I values with
caution in acute coronary syndrome patients with renal impairment to avoid overdiagnosis of myocardial infarction.
Further studies are recommended to establish adjusted diagnostic cutoff for troponin I in patients with impaired renal
function to improve the clinical decision making.