Chest pain and cardiac troponin flat curve: six-month prognosis of a cohort of patients

Introduction Acute myocardial injury is defined by cardiac troponin (cTn) levels above the 99th percentile with a dynamic change (Δ), often indicating acute coronary syndrome (ACS). Some patients present with chest pain and elevated cTn but with Δ<20% (flat curve). This study analyzes their prognosis based on management: admission to cardiology, to other departments, or discharge from emergency-department. Methods We prospectively analyzed data of patients with suspected ACS and cTn-flat curve (Δ<20% in two high-sensitivity cTn-T tests at 0/3 hours) from May 2023 to January 2025 (485 patients). Prognosis was based on major cardiovascular events (MACE) and non-cardiovascular events. Follow-up was completed in 331 patients (median 185 days). Results Mean age was 75.7±12.5 years, 60.4% male; 88 patients were admitted to cardiology, 73 to other departments, and 170 discharged. ACS was diagnosed in 52 (21%). Patients admitted to non-cardiology departments had higher MACE and non-cardiovascular events (Table 1). Kaplan-Meier curves (Figure 1) showed significant survival differences between admitted and discharged patients. Conclusions In patients with a cTn-T flat curve, event-free survival was low, particularly in those admitted to non-cardiology departments, where mortality was high and mainly non-cardiovascular. Discharged patients were not event-free but had low cardiac mortality rates.