Startseite Prognostic implication of elevated cardiac troponin I in patients visiting emergency department without diagnosis of coronary artery disease
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Prognostic implication of elevated cardiac troponin I in patients visiting emergency department without diagnosis of coronary artery disease

  • Minseok Song , Taerim Kim , Eun-Jin Kang , Jong Eun Park , Soo Hyun Park , Won Cul Cha , Hee Yoon , Sung Yeon Hwang , Tae Gun Shin , Min Seob Sim , IkJoon Jo , Hyung-Doo Park und Jin-Ho Choi EMAIL logo
Veröffentlicht/Copyright: 15. Januar 2021
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 59 Heft 6

Abstract

Objectives

Elevated cardiac troponin is not uncommon in patients visiting emergency department (ED) even without coronary artery disease, but its prognostic implication is not well understood in such patients.

Methods

In this retrospective single-center registry, we investigated clinical outcome of patients visiting ED without documented coronary artery disease. Patients were categorized according to the maximal value of Siemens ADVIA Centaur TnI-Ultra assay (TnI) within 24 h after visit. Primary endpoint was 180-day all-cause death that included cardiac and non-cardiac death.

Results

A total of 35,205 patients with median age 61 years and male gender 54.7% were included. Below the lowest level of detection (LOD) (≤0.006 ng/mL), between LOD and assay-specific <99th percentile (0.007–0.039 ng/mL), below median of ≥99th percentile (0.040–0.149 ng/mL), and above median of ≥99th percentile (≥0.150 ng/mL) TnI were found in 18,502 (52.6%), 11,338 (32.2%), 3,029 (8.6%), and 2,336 (6.6%) patients. In the 180-day follow-up period, 4,341 (12.3%) all-cause death including 694 (2.0%) cardiovascular death and 3,647 (10.4%) non-cardiovascular death developed. The risks of all-cause, cardiovascular, and non-cardiovascular death increased across higher TnI strata (hazard ratio [HR]=1.3 to 2.4; 2.0 to 9.3; 1.3 to 1.7; p<0.001, all). Analyses of multivariate models showed consistent results.

Conclusions

In patients visiting ED, elevated TnI was associated with higher risk of 180-day cardiovascular and non-cardiovascular death. Patients with elevated TnI may need additional evaluation or careful follow-up even without primary diagnosis of coronary artery disease.

Keywords: cardiac troponin; emergency department; risk prediction
Corresponding author: Jin-Ho Choi, MD, PhD, Professor, Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro, Gangnam-ku, 06355, Seoul, Republic of Korea, Phone: +82 2 3410 3419, E-mail:
Minseok Song and Taerim Kim contributed equally as first authors.

Funding source: Ministry of Trade Industry & Energy, Ministry of Science & ICT, Ministry of Health and Welfare under Technology Development Program for Ai-Bio-Robot-Medicine Convergence

Award Identifier / Grant number: 20001704

Funding source: National Research Foundation of Korea

Award Identifier / Grant number: 2017R1A2B310918

  1. Research funding: This study was supported by National Research Foundation of Korea (#2017R1A2B310918) and Ministry of Trade Industry & Energy, Ministry of Science & ICT, Ministry of Health and Welfare under Technology Development Program for Ai-Bio-Robot-Medicine Convergence (20001704).

  2. Author contributions: All authors had access to the data and a role in writing the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was waived given the retrospective design, the use of anonymized big database, and the reporting of aggregated results.

  5. Ethical approval: The Samsung Medical Center Institutional Review Board approved this study.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-1392).

Received: 2020-09-18
Accepted: 2020-12-22
Published Online: 2021-01-15
Published in Print: 2021-05-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-1392
Schlagwörter für diesen Artikel
cardiac troponin; emergency department; risk prediction

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. COVID-19: which lessons have we learned?
  4. Review
  5. Global FT4 immunoassay standardization: an expert opinion review
  6. Mini Review
  7. Mechanism of bilirubin elimination in urine: insights and prospects for neonatal jaundice
  8. Opinion Paper
  9. Laboratory medicine in the COVID-19 era: six lessons for the future
  10. EFLM Paper
  11. How to meet ISO15189:2012 pre-analytical requirements in clinical laboratories? A consensus document by the EFLM WG-PRE
  12. General Clinical Chemistry and Laboratory Medicine
  13. External quality assessment of M-protein diagnostics: a realistic impression of the accuracy and precision of M-protein quantification
  14. Error simulation modeling to assess the effects of bias and precision on bilirubin measurements used to screen for neonatal hyperbilirubinemia
  15. NT-proBNP levels in preeclampsia, intrauterine growth restriction as well as in the prediction on an imminent delivery
  16. Serum N-glycan fingerprint nomogram predicts liver fibrosis: a multicenter study
  17. Hematology and Coagulation
  18. Performance of digital morphology analyzer Vision Pro on white blood cell differentials
  19. Cardiovascular Diseases
  20. Prognostic implication of elevated cardiac troponin I in patients visiting emergency department without diagnosis of coronary artery disease
  21. Relationships between renal function variations and relative changes in cardiac troponin T concentrations based on quantile generalized additive models (qgam)
  22. Diabetes
  23. Association of hemoglobin H (HbH) disease with hemoglobin A1c and glycated albumin in diabetic and non-diabetic patients
  24. Comparative study of i-SENS glucometers in neonates using capillary blood samples
  25. Infectious Diseases
  26. Evaluation of four commercial, fully automated SARS-CoV-2 antibody tests suggests a revision of the Siemens SARS-CoV-2 IgG assay
  27. Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients
  28. Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study
  29. Letters to the Editors
  30. Global FT4 immunoassay standardization. Response to: Kratzsch J et al. Global FT4 immunoassay standardization: an expert opinion review
  31. Free-thyroxine standardization: waiting for Godot while well serving our patients today
  32. Prevalence of SARS-CoV-2 antibodies in health care personnel of two acute care hospitals in Linz, Austria
  33. Pediatric evaluation of clinical specificity and sensitivity of SARS-CoV-2 IgG and IgM serology assays
  34. Prevention and control of COVID-19 in the penitentiary of Florence
  35. Pooling for SARS-CoV-2-testing: comparison of three commercially available RT-qPCR kits in an experimental approach
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  37. Next-generation sequencing and RT-PCR to identify a 32-day SARS-CoV-2 carrier
  38. 25-Hydroxyvitamin D concentrations in COVID-19 patients hospitalized in intensive care unit during the first wave and the second wave of the pandemic
  39. Laboratory findings in a child with SARS-CoV-2 (COVID-19) multisystem inflammatory syndrome
  40. Discrepant cardiac troponin results in a young woman
  41. Response to: towards the rational utilization of SARS-CoV-2 serological tests in clinical practice
  42. Congress Abstract
  43. 12th National Scientific Congress SPML,29–31 October 2020, Online, Portugal
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