Clinical question: What is the association between high-sensitivity cardiac troponin T (hs-cTn) levels and outcomes in patients with chest pain?
Background: There are few data on the link between hs-cTn levels and outcomes in patients with chest pain but no myocardial infarction or any other condition that can cause acute increases in troponin levels.
Study design: Observational cohort study.
Setting: Patients older than 25 years old with chest pain presenting to the emergency department at a university hospital in Sweden.
Dr. Karen Clarke
Synopsis: 19,460 patients with chest pain who had at least one hs-cTn level obtained during their ED visit were included in this study. In comparison with patients who had hs-cTn less than 5 ng/L, the adjusted hazard ratios for all-cause mortality were 2.00, 2.92, 4.07, 6.77, and 9.68, in patients with hs-cTn levels of 5-9, 10-14, 15-29, 30-49, and 50 or greater ng/L, respectively. The yearly rates of MI were 0.3% and 4.5% in patients with hs-cTn levels less than 5 ng/L and 50 or greater ng/L, respectively. The yearly rates of hospitalization for heart failure were 0.1%, 1%, 2.8%, and 20% in patients with hs-cTn levels less than 5, 5-9, 10-14, and 50 or greater ng/L, respectively. There was a clear and graded association between any detectable levels of hs-cTn and risk factors for cardiovascular and noncardiovascular mortality, MI, and heart failure.
Bottom line: For patients with chest pain and stable troponin levels, there is an elevated risk of death, hospitalization for heart failure, and MI, if there is any detectable level of hs-cTn.
Citation: Roos A et al. Stable high-sensitivity cardiac troponin T levels and outcomes in patients with chest pain. J Am Coll Cardiol. 2017 Oct 31;70(18):2226-36. doi: 10.1016/j.jacc.2017.08.064.
Dr. Clarke is assistant professor of medicine in the division of hospital medicine, Emory University, Atlanta.
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