• Elif Hamzaçebioğlu, Bedriye Müge Sönmez, Gülşen Akçay, Murat Tulmaç, Süleyman Kayışoğlu, Semra Işıkoğlu Hatıl, and Elif Bengü Güngör.
• Department of Emergency Medicine, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
• Am J Emerg Med. 2024 Dec 13; 89: 9510295-102.

ObjectiveChronic kidney disease (CKD) patients with chest pain (CP) should receive special attention in the emergency department (ED). Evaluating troponin levels is highly confusing. This study aims to compare Cystatin C (CysC) and creatinine on troponin results in CKD patients with CP in ED.MethodsA prospective cross-sectional study was conducted on 174 patients with CKD who were admitted to ED with CP and registered with clinicaltrials.gov (NCT05303441). Patients were risk classified. Blood samples were collected for 0th-hour, 1st-hour, and 3rd-hour troponin levels and admission CysC level. Then they were grouped as they were diagnosed with ACS or not. CKD-EPI formula was used to calculate Glomerular filtration rate (GFR) with creatinine, CysC and cyscrea for each patient (https://www.kidney.org/professionals/kdoqi/gfr_calculator).ResultsThe overall rate of CKD stage change calculated with creatinine to another stage with CysC was 52.87 % in all groups. There was a highly significant correlation between creatinine and CysC levels with 1st-hour and 3rd-hour troponin levels in both ACS and non-ACS groups (r = 0.809 and 0.810, respectively; r = 0.908 and 0.912, respectively). The prediction equations between creatinine, CysC, and troponin were as 0th-hour troponin = 1.553 + 1.074creatinine and 0th-hour troponin = 1.580 + 0.837cystatin C, respectively. 3rd-hour troponin level had a markedly good predictive power for ACS (AUC = 0.813, p < 0.001; sensitivity 74.7 %, specificity 74.7 %) with a cut-off value of 64.50.ConclusionCysC can be preferable in CKD patients with CP due to the stage change and the decisive effect of CysC on troponin compared to creatinine in patients with and without ACS.Copyright © 2024 Elsevier Inc. All rights reserved.

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