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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (2): 191-203     DOI: 10.31083/j.rcm.2020.02.17
Special Issue: Cardiovascular disorders in chronic kidney disease
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High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond
Anthony (Ming-yu) Chuang1, 2, *(), Mau T Nguyen3, Woon-Man Kung4, Sam Lehman1, 2, Derek P Chew1, 2
1School of Medicine, Flinders University of South Australia, Adelaide 5042, Australia
2Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide 5042, Australia
3Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide 5000, Australia
4Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei 11114, Taiwan
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Acute myocardial infarction (MI) represents one of the most common hospital encounters, with significant short-term and long-term morbidity and mortality, and frequently occurs in patients with chronic kidney disease (CKD). Cardiac troponin is an exquisitely sensitive biomarker for myocardial injury and plays an essential role in the diagnosis, risk-stratification, and management of MI. In 2017, the United States Food and Drug Administration approved Roche Diagnostics' 5th generation high-sensitivity cardiac troponin (hs-cTn) for clinical use. Whilst the improved analytical sensitivity of these new high-sensitivity troponin assays facilitate early diagnosis of MI, it also frequently identifies troponin elevations above the conventional reference threshold in the context of non-coronary conditions such as renal dysfunction, and can represent a major diagnostic challenge to clinicians. Furthermore, the optimal management strategy of patients with troponin elevation and high comorbidity burden, a common issue in patients with CKD, remains undefined. In recent years, there has been substantial research and progress undertaken in this rapidly evolving area. In this review, we aim to provide clinicians with an overview of hs-cTn in the setting of CKD as well as an update on its application and the particular considerations involved in the management of myocardial infarction, stable coronary artery disease and myocardial injury in this high risk population.
Key words:  High-sensitivity troponin      chronic kidney disease      coronary artery disease      myocardial injury      dialysis     
Submitted:  04 February 2020      Revised:  16 April 2020      Accepted:  20 April 2020      Published:  30 June 2020     
*Corresponding Author(s):  Anthony (Ming-yu) Chuang     E-mail:

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Anthony (Ming-yu) Chuang, Mau T Nguyen, Woon-Man Kung, Sam Lehman, Derek P Chew. High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond. Reviews in Cardiovascular Medicine, 2020, 21(2): 191-203.

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