Problems of diagnosing non-ST-segment elevation myocardial infarction in patients with chronic kidney disease

Abstract

The review presents the results of studies showing an increased risk of non-ST-segment elevation myocardial infarction (NSTEMI) in patients with chronic kidney disease (CKD). However, there are still some difficulties in diagnosing this condition in patients of this group. Atypical symptoms of the disease, nonspecific changes in the ST segment and T wave on the electrocardiogram, and initially elevated levels of high-sensitivity cardiac troponins (hs-cTn) are the reasons for late diagnosis and suboptimal treatment of NSTEMI in patients with CKD. High levels of hs-cTn in patients with NSTEMI and CKD are associated with a poor cardiovascular prognosis. It has been shown that hs-cTn testing can maintain its high diagnostic accuracy in patients with CKD when optimized threshold values are used in short algorithms. Optimal threshold levels should be individually determined for each test produced by different companies. Currently, there is no unified algorithm for confirming or excluding NSTEMI using hs-cTn in patients with CKD.