P4689Comparison of high-sensitivity troponin T (hs-TnT) and high-sensitivity troponin I (hs-TnI) in the exclusion of acute coronary syndrome in patients with chest pain in the emergency department

Tan, Hong Qi; Lim, Swee Han; Chua, Terrance; Wong, Aaron; Sahlén, Anders; Koh, Angela S.; Yeo, Khung‐Keong; Koh, Natalie; Chin, Calvin; Gao, Fei; Zarisfi, Faraz; Ong, Marcus Eng Hock; Pothiawala, Sohil; Yeo, Chin Pin; Tan, Jennifer K.

doi:10.1093/eurheartj/ehx504.p4689

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“…Chest pain is one of the most common chief complaints in the emergency department (ED), and an ongoing diagnostic challenge for clinicians. Risk scores and evaluation methods rely mostly upon a negative cardiac troponin laboratory result, speci cally, high-sensitive cardiac troponin (hs-cTn) levels, when trying to differentiate between low-or intermediate-risk from high-risk patients as well as patients with potential acute coronary syndrome (ACS) (1)(2)(3)(4)(5). The updated European Society of Cardiology (ESC) guidelines advocate very low (unmeasurable) hs-cTn levels to safely rule out acute myocardial infraction (AMI) employing the 0/1 hour rule, with a high negative predictive value of 30-day mortality and AMI occurrence in patients who had been discharged from the ED (6, 7).…”

Section: Introductionmentioning

confidence: 99%

Outcomes after ED visit for acute Chest Pain, with respect to negative but measurable troponin levels and CRP levels

Greenberg,

Cohen,

Shopen

et al. 2024

Preprint

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While chest pain is one of the most common chief complaints in the ED, the majority are discharged for ambulatory care. We explored outcomes of patients who presented to the ED with chest pain as chief compliant, and assessed whether an association exists with negative (but measurable) troponin levels or elevated CRP levels. The primary outcome was a percutaneous intervention (PCI) within 90 days from ED visit, and the secondary outcomes were 7-day revisit, 14-day ward admission, and 30-day mortality. Of 32,170 patients who presented with chest pain to the ED during the 5-year study period, 23,442 (73%) were discharged from the ED and 8,720 were admitted. Among the discharged 14,477 (61.8%) had very-low troponin, of whom only 70 (0.5%) had PCI withing 90 days, compared with 1.9% in patients with negative but measurable troponin levels (n = 169, p < 0.0001). All the secondary outcomes were higher among patients with negative but measurable troponin compared to very-low troponin: 7-days ED revisit rates were 5.3% compared with 3.3% respectively (p < 0.0001), 14-days admission rates were 3.2% and 0.9% respectively (p < 0.0001) and mortality rates were 0.3% compared to 0.01% (p < 0.0001). Troponin levels ≥ 3.5 ng/L were associated with 90-day PCI (aOR 2.0, [95% CI: 1.5–2.7], p < 0.001). An elevated CRP level was an independent protective factor against 90-day PCI (aOR 0.98, p = 0.03), but was associated with all the other outcomes. While nearly 3/4 of ED chest pain visits can be discharge safely, measurable troponin levels may suggest the need for imminent coronary intervention.

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Section: Introductionmentioning

confidence: 99%