Diagnosis of ACS in renal patients using hsTnT & PAPP-A (v.1)

• Research type

  Research Study

• Full title

  Diagnostic performance of high-sensitivity Troponin T and Pregnancy-associated Plasma Protein A for the detection of acute coronary syndrome in patients with renal impairment.

• IRAS ID

  160668

• Contact name

  Rachel Still

• Contact email

  rachel.still@wales.nhs.uk

• Duration of Study in the UK

  0 years, 6 months, 16 days

• Research summary

  Can PAPP-A be used alongside cardiac hs-Troponin T as a valid diagnostic marker of acute coronary syndrome (ACS) in patients with renal impairment?
  Troponin T is a protein released after cardiac muscle cell injury and therefore has been routinely measured for diagnosis of myocardial infarction (heart attack) and other acute coronary syndrome. Interpretation of Troponin T levels in patients with renal dysfunction is difficult with little guidance from advisory bodies. Increased Troponin T levels in patients with renal impairment, without the expected cardiac injury have been documented in many sources of literature and have been attributed to decreased renal function. With the emergence of new biomarkers of atherosclerotic plaque rupture i.e. human pregnancy-associated plasma protein-A, investigation of Troponin T levels in renal patients could be undertaken with additional PAPP-A measurement to aid confirmation of an acute cardiac event and to potentially develop an amended reference range for Troponin T. Troponin T and PAPP-A can be measured on blood samples by electrochemiluminescence immunoassay on patients with renal disease to establish the effect of decreased renal function on Troponin T and PAPP-A levels. The inclusion of a negative reference group to establish a baseline level in ‘healthy’ individuals, and a positive reference group to establish an ‘abnormal’ level in individuals with confirmed acute coronary syndrome will futher validate the results obtained. PAPP-A measurement will only be added on to existing samples that have already requested Troponin T, limiting the ethical implications. No additional samples will be taken. This research will potentially enhance our ability to interpret increased Troponin T levels in patients with renal impairment. The research is funded by the research and development fund of the Laboratory Medicine department of Abertawe BroMorganwg University health board. The proposed time-scale is 9 months from submission of project proposal to thesis submission.

• REC name

  South West - Cornwall & Plymouth Research Ethics Committee

• REC reference

  15/SW/0091

• Date of REC Opinion

  25 Mar 2015

• REC opinion

  Favourable Opinion