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Cyon L, Kadesjö E, Edgren G, Roos A. Long-term prognosis of low high-sensitivity cardiac troponin T in the emergency department compared with the general population. Heart 2024; 110:1040-1047. [PMID: 38849151 PMCID: PMC11287531 DOI: 10.1136/heartjnl-2024-323913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Long-term prognosis associated with low-high-sensitivity cardiac troponin T (hs-cTnT) concentrations in patients with chest pain is unknown. We investigated these prognostic implications compared with the general population. METHODS All first visits to seven emergency departments (ED)s in Sweden were included from 9 December 2010 to 31 August, 2017 by patients presenting with chest pain and at least one hs-cTnT measured. Patients with myocardial injury (any hs-cTnT >14 ng/L), including patients with myocardial infarction (MI) were excluded. Standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs) were calculated as the ratio of the number of observed to expected events. The expected number was computed by multiplying the 1-year calendar period-specific, age-specific and sex-specific follow-up time in the cohort with the corresponding incidence in the general population. HRs were calculated for all-cause mortality and major adverse cardiovascular events (MACE), defined as acute MI, heart failure hospitalisation, cerebrovascular stroke or cardiovascular death, between patients with undetectable (<5 ng/L) and low (5-14 ng/L) hs-cTnT. RESULTS A total of 1 11 916 patients were included, of whom 69 090 (62%) and 42 826 (38%) had peak hs-cTnT concentrations of <5 and 5-14 ng/L. Patients with undetectable peak hs-cTnT had a lower mortality risk compared with the general Swedish population (SMR 0.83, 95% CI 0.79 to 0.87), with lower risks observed in all patients ≥65 years of age, but a slightly higher risk of being diagnosed with a future MI (SIR 1.39, 95% CI 1.32 to 1.47). The adjusted risk of a first MACE associated with low versus undetectable peak hs-cTnT was 1.6-fold (HR 1.61, 95% CI 1.53 to 1.70). CONCLUSION Patients with chest pain and undetectable hs-cTnT have an overall lower risk of death compared with the general population, with risks being highly age dependent. Detectable hs-cTnT concentrations are still associated with increased long-term cardiovascular risks.
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Affiliation(s)
- Love Cyon
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Erik Kadesjö
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Edgren
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Andreas Roos
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Inoue K, Chieh JTW, Yeh LC, Chiang SJ, Phrommintikul A, Suwanasom P, Kasim S, Ahmad B, Idrose AM, Salleh FM, Oyamada S, Hirano Y, Ouchi S, Terakura M, Yokoyama N, Kozuma K, Nanasato M, Higuchi R, Yumoto K, Fukuzawa T, Shimada I, Giannitsis E, Twerenbold R, Minamino T. An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study. Trials 2022; 23:986. [PMID: 36476401 PMCID: PMC9727900 DOI: 10.1186/s13063-022-06907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND More than half of the world's population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data. METHODS The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply "usual care" according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED. CONCLUSIONS This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
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Affiliation(s)
- Kenji Inoue
- grid.482668.60000 0004 1769 1784Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Jack Tan Wei Chieh
- grid.419385.20000 0004 0620 9905Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Lim Chiw Yeh
- grid.419385.20000 0004 0620 9905Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Shuo-Ju Chiang
- grid.410769.d0000 0004 0572 8156Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Arintaya Phrommintikul
- grid.7132.70000 0000 9039 7662Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Pannipa Suwanasom
- grid.7132.70000 0000 9039 7662Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Sazzli Kasim
- grid.412259.90000 0001 2161 1343Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Bakhtiar Ahmad
- grid.412259.90000 0001 2161 1343Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Alzamani Mohammad Idrose
- grid.412516.50000 0004 0621 7139Division of Emergency, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Farina Mohd Salleh
- grid.419388.f0000 0004 0646 931XDivision of Emergency, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Yohei Hirano
- grid.482669.70000 0004 0569 1541Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Biology and Medicine, Juntendo Urayasu Hospital, Chiba, Japan
| | - Moriyuki Terakura
- grid.264706.10000 0000 9239 9995Department of Emergency, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Yokoyama
- grid.264706.10000 0000 9239 9995Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- grid.264706.10000 0000 9239 9995Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Mamoru Nanasato
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiko Yumoto
- grid.410819.50000 0004 0621 5838Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tomoyuki Fukuzawa
- grid.410819.50000 0004 0621 5838Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | | | - Evangelos Giannitsis
- grid.5253.10000 0001 0328 4908Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Raphael Twerenbold
- grid.13648.380000 0001 2180 3484Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tohru Minamino
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Schrader CD, Meyering SH, Kumar D, Alanis N, D'Etienne JP, Shaikh S, Vo V, Kamaria AR, Huettner N, Wang H. The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers. High Blood Press Cardiovasc Prev 2020; 28:69-78. [PMID: 33369723 DOI: 10.1007/s40292-020-00426-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/13/2020] [Indexed: 12/23/2022] Open
Abstract
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.
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Affiliation(s)
- Chet D Schrader
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Stefan H Meyering
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Darren Kumar
- Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Naomi Alanis
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - James P D'Etienne
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Vietvuong Vo
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Ankur R Kamaria
- Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Nicole Huettner
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
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4
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Giannitsis E, Clifford P, Slagman A, Ruedelstein R, Liebetrau C, Hamm C, Honnart D, Huber K, Vollert JO, Simonelli C, Schröder M, Wiemer JC, Mueller-Hennessen M, Schroer H, Kastner K, Möckel M. Multicentre cross-sectional observational registry to monitor the safety of early discharge after rule-out of acute myocardial infarction by copeptin and troponin: the Pro-Core registry. BMJ Open 2019; 9:e028311. [PMID: 31340965 PMCID: PMC6661885 DOI: 10.1136/bmjopen-2018-028311] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/16/2019] [Accepted: 06/25/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There is sparse information on the safety of early primary discharge from the emergency department (ED) after rule-out of myocardial infarction in suspected acute coronary syndrome (ACS). This prospective registry aimed to confirm randomised study results in patients at low-to-intermediate risk, with a broader spectrum of symptoms, across different institutional standards and with a range of local troponin assays including high-sensitivity cTn (hs-cTn), cardiac troponin (cTn) and point-of-care troponin (POC Tn). DESIGN Prospective, multicentre European registry. SETTING 18 emergency departments in nine European countries (Germany, Austria, Switzerland, France, Spain, UK, Turkey, Lithuania and Hungary) PARTICIPANTS: The final study cohort consisted of 2294 patients (57.2% males, median age 57 years) with suspected ACS. INTERVENTIONS Using the new dual markers strategy, 1477 patients were eligible for direct discharge, which was realised in 974 (42.5%) of patients. MAIN OUTCOME MEASURES The primary endpoint was all-cause mortality at 30 days. RESULTS Compared with conventional workup after dual marker measurement, the median length of ED stay was 60 min shorter (228 min, 95% CI: 219 to 239 min vs 288 min, 95% CI: 279 to 300 min) in the primary dual marker strategy (DMS) discharge group. All-cause mortality was 0.1% (95% CI: 0% to 0.6%) in the primary DMS discharge group versus 1.1% (95% CI: 0.6% to 1.8%) in the conventional workup group after dual marker measurement. Conventional workup instead of discharge despite negative DMS biomarkers was observed in 503 patients (21.9%) and associated with higher prevalence of ACS (17.1% vs 0.9%, p<0.001), cardiac diagnoses (55.2% vs 23.5%, p<0.001) and risk factors (p<0.01), but with a similar all-cause mortality of 0.2% (95% CI: 0% to 1.1%) versus primary DMS discharge (p=0.64). CONCLUSIONS Copeptin on top of cardiac troponin supports safe discharge in patients with chest pain or other symptoms suggestive of ACS under routine conditions with the use of a broad spectrum of local standard POC, conventional and high-sensitivity troponin assays. TRIAL REGISTRATION NUMBER NCT02490969.
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Affiliation(s)
| | | | - Anna Slagman
- Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité Universitiy Medicine, Berlin, Germany
- College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | | | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
- Partner Site, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
- Partner Site, German Center for Cardiovascular Research (DZHK), Frankfurt am Main, Germany
| | | | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Jörn Ole Vollert
- Cardiovascular Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Carlo Simonelli
- Cardiovascular Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Malte Schröder
- Cardiology, Krankenhaus Hedwigshohe Berlin, Berlin, Germany
| | - Jan C Wiemer
- Cardiovascular Biomarkers, Thermo Fisher Scientific, Hennigsdorf, Germany
| | | | - Hinrich Schroer
- Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Kim Kastner
- Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité Universitiy Medicine, Berlin, Germany
| | - Martin Möckel
- Department of Emergency Medicine CVK, CCM and Department of Cardiology CVK, Charité Universitiy Medicine, Berlin, Germany
- College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
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Giannitsis E, Biener M, Hund H, Mueller-Hennessen M, Vafaie M, Gandowitz J, Riedle C, Löhr J, Katus HA, Stoyanov KM. Management and outcomes of patients with unstable angina with undetectable, normal, or intermediate hsTnT levels. Clin Res Cardiol 2019; 109:476-487. [DOI: 10.1007/s00392-019-01529-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022]
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6
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Giannitsis E, Katus HA. Troponins: established and novel indications in the management of cardiovascular disease. Heart 2018; 104:1714-1722. [PMID: 29724751 DOI: 10.1136/heartjnl-2017-311387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Hugo A Katus
- Medizinische Klinik III, University of Heidelberg, Heidelberg, Germany
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7
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Nejatian A, Omstedt Å, Höijer J, Hansson LO, Djärv T, Eggers KM, Svensson P. Outcomes in Patients With Chest Pain Discharged After Evaluation Using a High-Sensitivity Troponin T Assay. J Am Coll Cardiol 2017; 69:2622-2630. [PMID: 28545635 DOI: 10.1016/j.jacc.2017.03.586] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most patients with chest pain are discharged from the emergency department (ED) with the diagnosis "unspecified chest pain." It is unknown if evaluation with a high-sensitivity troponin T (hsTnT) assay affects prognosis in this large population. OBJECTIVES The aim was to investigate whether the introduction of an hsTnT assay is associated with reduced incidence of major adverse cardiac events (MACEs) and cardiovascular (CV) risk profile in patients with chest pain discharged from the ED. METHODS The study included 65,696 patients with "unspecified chest pain" discharged from 16 Swedish hospital EDs between 2006 and 2013 in which an hsTnT assay was introduced as the clinical routine. Patients evaluated with a conventional and an hsTnT assay were compared regarding the occurrence of 30-day MACE and CV risk profile based on information from national registries. Patients directly discharged and those discharged after an initial admission were analyzed separately. RESULTS Fewer directly discharged patients experienced a MACE when evaluated with an hsTnT compared with a conventional assay (0.6% vs. 0.9%; odds ratio [OR]: 0.7; 95% confidence interval [CI]: 0.57 to 0.83). In contrast, more patients discharged after an initial admission experienced a MACE when evaluated with an hsTnT (7.2% vs. 3.4%; OR: 2.18; 95% CI: 1.76 to 2.72). Admitted patients had a higher general CV risk profile when evaluated with hsTnT, whereas directly discharged patients had a lower general CV risk profile with the same test. CONCLUSIONS Patients directly discharged from the ED with unspecified chest pain experienced fewer MACEs and had a better risk profile when evaluated with hsTnT. Our findings suggest that more true at-risk patients were identified and admitted. The implementation of hsTnT assays in Swedish hospitals has improved evaluations in the ED.
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Affiliation(s)
- Atosa Nejatian
- Functional Area of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Åsa Omstedt
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics IMM, Karolinska Institutet, Stockholm, Sweden
| | - L O Hansson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Therese Djärv
- Functional Area of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kai M Eggers
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Svensson
- Functional Area of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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8
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Trends in admissions for chest pain after the introduction of high-sensitivity cardiac troponin T. Int J Cardiol 2017; 240:1-7. [DOI: 10.1016/j.ijcard.2017.04.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/08/2017] [Accepted: 04/10/2017] [Indexed: 11/23/2022]
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9
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Potezny T, Horwood CM, Hakendorf P, Papendick C, Thompson CH. Predicting re-presentation following presentation to the emergency department with non-specific chest pain. Intern Med J 2017. [DOI: 10.1111/imj.3_13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Potezny
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - CM Horwood
- Clinical Epidemiology, Flinders Medical Centre; Bedford Park South Australia Australia
| | - P Hakendorf
- Clinical Epidemiology, Flinders Medical Centre; Bedford Park South Australia Australia
| | - C Papendick
- Department of Emergency Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - CH Thompson
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Carlsson AC, Bandstein N, Roos A, Hammarsten O, Holzmann MJ. High-sensitivity cardiac troponin T levels in the emergency department in patients with chest pain but no myocardial infarction. Int J Cardiol 2016; 228:253-259. [PMID: 27865194 DOI: 10.1016/j.ijcard.2016.11.087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) was recently introduced into clinical practice. The increased sensitivity has decreased the specificity. We aimed to determine the predictors for and prevalence of hs-cTnT levels above the 99th percentile in a stable population of patients without myocardial infarction (MI) who sought medical attention for chest pain in the emergency department. METHODS We included 11,847 patients with chest pain and at least one hs-cTnT measurement during 2011 and 2012. Patients with any acute reasons for an elevated hs-cTnT level were excluded. We used logistic regression to calculate adjusted odds ratios with 95% confidence intervals for the association between patient characteristics and hs-cTnT levels of >14ng/L. We also determined 50th, 75th, 97.5th, and 99th percentile values of hs-cTnT levels in relation to age, sex, estimated glomerular filtration rate (eGFR), and presence or absence of comorbidities. RESULTS In total, 1360 (11%) patients had hs-cTnT levels of >14ng/L. Men had higher troponin levels than women, and older patients had higher levels than younger patients. The strongest predictor of an elevated troponin level was a reduced eGFR. The 99th percentile for hs-cTnT among all men and among women <50years of age with normal renal function was 20 and 12ng/L, respectively; this level increased to 44 and 36ng/L, respectively, at the age of 70-79years. CONCLUSIONS A hs-cTnT level above the 99th percentile in patients with chest pain but no MI is common and is related to sex, age, and eGFR.
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Affiliation(s)
- Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Nadia Bandstein
- Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Andreas Roos
- Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin J Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
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