Patients discharged with elevated baseline high-sensitive cardiac troponin T from the emergency department

Abstract

Background

Elevated levels of high-sensitive cardiac troponin T (hs-cTnT) are linked to poor prognosis among emergency department (ED) patients.

Objective

Examine the effect of our ED risk assessment among patients with suspected acute coronary syndrome (ACS) and elevated baseline hs-cTnT levels.

Design

Observational cohort study of 16776 ED patients with chest pain or dyspnoea and a hs-cTnT sample analyzed at the time of the ED visit. Of these 1480 patients were sent home with elevated hs-cTnT levels (>14 ng/L).

Methods

Analysis of clinical and laboratory data from the local hospital and data from the National Board of Health and Welfare.

Results

Admitted patients had 11% and discharged patients had 1.2% 90-day mortality indicating effective risk assessment of patients with suspected ACS. However, if the suspected ACS patient presented with hs-cTnT between 14 and 22 ng/L, the 90-day mortality was 4.1% among discharged and 6.7% among admitted patients. Among discharged patients, an hs-cTnT level above 14 ng/L was a higher independent risk factor for 90-day mortality (HR 3.3, 95% CI 2.9–3.7, p < 0.001) than if the patient was triaged as a high-risk patient (HR 1.6, 95% CI 1.1–1.8, p < 0.001).

Conclusions

Our ED risk assessment was less effective among patients presenting with elevated hs-cTnT levels.

Keywords:

• Cardiovascular disease
• cardiac troponin
• emergency department risk assessment
• acute coronary syndrome
• chest pain

Acknowledgements

We thank Birgitta Hillvärn for her invaluable expertise with the hospital databases. We also thank Fakhri Quraishi for his outstanding expertise and handling of the laboratory databases.

Ethical approval

The study was approved by the Ethics Committee at the University of Gothenburg, and the study protocol followed the ethical guidelines of the 1975 Declaration of Helsinki.

Author contributions

Christian Bjurman, Matteus Zywczyk, Max Petzold, Martin Holzmann, Soza Zangana and Ola Hammarsten have contributed significantly to the conception and design of the manuscript and the interpretation of data, to the drafting of the article, and to the revisions for important intellectual content and the final approval of the version to be published. Christian Bjurman, Matteus Zywczyk, Soza Zangana and Max Petzold have also worked on the acquisition and analysis of data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Swedish Cancer Society, the Swedish Research Council, the Assar Gabrielsson Cancer Research Foundation, and by LUA/ALF Funding at Sahlgrenska University Hospital.