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. 2024 Nov 26;24(1):223.
doi: 10.1186/s12873-024-01128-1.

Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels

Sharon A Greenberg #  1 , Neta Cohen #  2 , Noa Shopen  3 , Reut Aviv Mordechai  3 , David Zeltser  3 , Julieta Werthein  3
Affiliations

Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels

Sharon A Greenberg et al. BMC Emerg Med. .

Abstract

Background: Chest pain is a common condition in the emergency department (ED). High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing acute coronary syndrome, but the implications of "negative but measurable" hs-cTn levels are not well understood. This study assesses the outcomes of patients with acute chest pain discharged from the ED based on their hs-cTn levels.

Methods: This retrospective cohort study analyzed medical records of patients aged 18 and older presenting with chest pain to the Tel Aviv Sourasky Medical Center ED from 2017 to 2022. We compared patients with negative but measurable hs-cTn levels (3-50 ng/L) to those with very low hs-cTn levels (< 3 ng/L). Primary outcomes included 90- days coronary angiogram (CAG), and secondary outcomes were 7- days ED revisits, 14-days hospital admissions, and 30- days mortality.

Results: Of 32,162 eligible patients, 23,297 had hs-cTn levels ≤ 50 ng/L. Patients with negative but measurable hs-cTn levels had higher rates of 90-days CAG (1.8% vs. 0.5%, p < 0.001), 7-day ED revisits (5.2% vs. 3.3%, p < 0.001), 14-day hospital admissions (3.1% vs. 0.9%, p < 0.001), and 30-day mortality (0.3% vs. 0.01%, p < 0.001) compared to those with very low hs-cTn levels. Independent predictors for 90 days CAG included age ≥ 57 years, male sex, and hs-cTn ≥ 3.5 ng/L.

Conclusions: Negative but measurable hs-cTn levels are linked to worse outcomes than very low hs-cTn levels in discharged ED patients. Closer follow-up and further cardiac evaluation may be warranted for these patients.

Keywords: Chest pain; ED discharge; Outcomes after discharge; Troponin.

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Conflict of interest statement

Declarations. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and approved by the Tel-Aviv Sourasky Medical Center Institutional Review Board (Study number: TLV-22-0151). The need for consent to participate was waived by an Institutional Review Board. Consent for participate: Not applicable as written informed consent was not necessary because no patient data has been included in the manuscript. The need for consent to participate was waived by an Institutional Review Board (Study number: TLV-22-0151). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patients flow chart. ED = Emergency department, CAG = cardiac angiogram, UNL = upper normal limit
Fig. 2
Fig. 2
Primary and secondary outcomes in patients with very low hs-cTn and patients with negative but measurable hs-cTn levels. CAG: cardiac angiogram, ED: emergency department, hs-cTn: high-sensitive cardiac troponin
Fig. 3
Fig. 3
Roc curve for age and troponin level and the risk for 90 days CAG. Age: AUC 0.75, p < 0.001. hs-cTn levels: AUC 0.685, p < 0.001. AUC = Area under the curve. CAG = cardiac angiogram
See this image and copyright information in PMC

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