Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study
Background: The ideal high-sensitivity troponin (hsTn) cutoff for identifying those at low risk of 30 days events is debated; however, the 99th percentile overall or gender-specific upper reference limit (URL) is most commonly used. The magnitude of risk and the best management strategy for those wi...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-10-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906720302840 |
| _version_ | 1818279342251180032 |
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| author | Osama Mahmoud Hadi Mahmaljy Mohamed Youniss Edwin Hernandez Campoverde Hadi Elias Matthew Stanton Maulin Patel Insia Hashmi Katelyn Young Rajesh Kuppuraju Steven Jacobs Amro Alsaid |
| author_facet | Osama Mahmoud Hadi Mahmaljy Mohamed Youniss Edwin Hernandez Campoverde Hadi Elias Matthew Stanton Maulin Patel Insia Hashmi Katelyn Young Rajesh Kuppuraju Steven Jacobs Amro Alsaid |
| author_sort | Osama Mahmoud |
| collection | DOAJ |
| description | Background: The ideal high-sensitivity troponin (hsTn) cutoff for identifying those at low risk of 30 days events is debated; however, the 99th percentile overall or gender-specific upper reference limit (URL) is most commonly used. The magnitude of risk and the best management strategy for those with low-level hsTn elevation hasn’t been extensively studied. Methods: We conducted a retrospective cohort analysis including 4396 chest pain patients (542 with low-level hsTn elevation) who ruled out for myocardial infarction (MI), had a stable high-sensitivity troponin T (hsTnT) levels (defined as < 5 ng/l inter-measurements increase in hsTnT levels), and were discharged from the emergency department without further ischemic testing. The aim of the study was to compare the 30-day incidence of adverse cardiac events (ACE) between patients with undetectable high-sensitivity troponin T (hsTnT) (group 1), patients with hsTnT within the 99th percentile sex-specific URL (group 2), and patients with low-level hsTnT elevation (between the 99th percentile URL and ≤ 50 ng/l) (group 3). Results: 30-day event rates were very low 0.1%, 0.6%, and 0.4% for hsTnT groups 1, 2, and 3 respectively (overall P = 0.041, for groups 2 & 3 interaction P = 0.74). 30-day all-cause mortality, as well as 1-year all-cause and cardiovascular mortalities, occurred more frequently in those with low-level hsTnT elevation as did 1-year composite ACE. Conclusion: In conclusion, 30-day adverse event rates were very low in those with stable low-level hsTnT elevation who ruled out for MI and were discharged from the emergency department without further inpatient testing. |
| first_indexed | 2024-12-12T23:31:48Z |
| format | Article |
| id | doaj.art-c4378e4fce92422486a285d9e3a16899 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-12T23:31:48Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-c4378e4fce92422486a285d9e3a168992022-12-22T00:07:46ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-10-0130100586Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort studyOsama Mahmoud0Hadi Mahmaljy1Mohamed Youniss2Edwin Hernandez Campoverde3Hadi Elias4Matthew Stanton5Maulin Patel6Insia Hashmi7Katelyn Young8Rajesh Kuppuraju9Steven Jacobs10Amro Alsaid11Heart Institute, Geisinger Medical Center, United States; Corresponding author at: Heart Institute, Geisinger Medical Center, 100 N. Academy Ave. Danville, PA 17822, United States.Heart Institute, Geisinger Medical Center, United StatesHeart Institute, Geisinger Medical Center, United StatesHeart Institute, Geisinger Medical Center, United StatesHeart Institute, Geisinger Medical Center, United StatesDepartment of Internal Medicine, Geisinger Medical Center, United StatesDepartment of Internal Medicine, Geisinger Medical Center, United StatesDepartment of Internal Medicine, Geisinger Medical Center, United StatesDepartment of Internal Medicine, Geisinger Medical Center, United StatesDepartment of Internal Medicine, Geisinger Medical Center, United StatesDepartment of Internal Medicine, Geisinger Medical Center, United StatesHeart Institute, Geisinger Medical Center, United StatesBackground: The ideal high-sensitivity troponin (hsTn) cutoff for identifying those at low risk of 30 days events is debated; however, the 99th percentile overall or gender-specific upper reference limit (URL) is most commonly used. The magnitude of risk and the best management strategy for those with low-level hsTn elevation hasn’t been extensively studied. Methods: We conducted a retrospective cohort analysis including 4396 chest pain patients (542 with low-level hsTn elevation) who ruled out for myocardial infarction (MI), had a stable high-sensitivity troponin T (hsTnT) levels (defined as < 5 ng/l inter-measurements increase in hsTnT levels), and were discharged from the emergency department without further ischemic testing. The aim of the study was to compare the 30-day incidence of adverse cardiac events (ACE) between patients with undetectable high-sensitivity troponin T (hsTnT) (group 1), patients with hsTnT within the 99th percentile sex-specific URL (group 2), and patients with low-level hsTnT elevation (between the 99th percentile URL and ≤ 50 ng/l) (group 3). Results: 30-day event rates were very low 0.1%, 0.6%, and 0.4% for hsTnT groups 1, 2, and 3 respectively (overall P = 0.041, for groups 2 & 3 interaction P = 0.74). 30-day all-cause mortality, as well as 1-year all-cause and cardiovascular mortalities, occurred more frequently in those with low-level hsTnT elevation as did 1-year composite ACE. Conclusion: In conclusion, 30-day adverse event rates were very low in those with stable low-level hsTnT elevation who ruled out for MI and were discharged from the emergency department without further inpatient testing.http://www.sciencedirect.com/science/article/pii/S2352906720302840High-sensitivity troponinAcute chest painStable low-level high sensitivity troponin elevationChest pain triage |
| spellingShingle | Osama Mahmoud Hadi Mahmaljy Mohamed Youniss Edwin Hernandez Campoverde Hadi Elias Matthew Stanton Maulin Patel Insia Hashmi Katelyn Young Rajesh Kuppuraju Steven Jacobs Amro Alsaid Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study International Journal of Cardiology: Heart & Vasculature High-sensitivity troponin Acute chest pain Stable low-level high sensitivity troponin elevation Chest pain triage |
| title | Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study |
| title_full | Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study |
| title_fullStr | Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study |
| title_full_unstemmed | Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study |
| title_short | Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain. A single-center retrospective cohort study |
| title_sort | comparative outcome analysis of stable mildly elevated high sensitivity troponin t in patients presenting with chest pain a single center retrospective cohort study |
| topic | High-sensitivity troponin Acute chest pain Stable low-level high sensitivity troponin elevation Chest pain triage |
| url | http://www.sciencedirect.com/science/article/pii/S2352906720302840 |
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