Key result
Patients presenting to the emergency department with chest pain and a history of dyslipidemia had a significantly higher risk of developing acute coronary syndrome compared to those without dyslipidemia (RR 1.62).
Why the study?
The study evaluated presenting symptoms, risk factors, cardiac origin of Hs-TnI, emergency physician utilization tendencies, and the validity of routinely requesting Hs-TnI in the ER.
Do presenting symptoms and risk factors predict acute coronary syndrome in emergency department patients undergoing high-sensitivity troponin I testing?
Cohort (n=904)
No
Do presenting symptoms and risk factors predict acute coronary syndrome in emergency department patients undergoing high-sensitivity troponin I testing?
Targeted use of high-sensitivity troponin I based on presenting symptoms and risk factors like dyslipidemia yields better diagnostic value for ACS than random screening in the emergency department.
May aid ACS risk stratification in ED chest pain; leaves open whether symptom-guided hs-troponin testing improves outcomes.
Objectives: The aim of this study is to evaluate the presenting symptoms, risk factors and cardiac origin of high-sensitivity troponin I (Hs-TnI), the tendency of emergency physicians to use Hs-TnI in a general emergency room (ER) and the validity of requesting an Hs-TnI routinely. Methodology: A retrospective cohort study with 904 patients presenting at a tertiary hospital ER with an Hs-TnI requested. The study was conducted for 15 months. Results: Of the sample, 20.4% (n = 184) presented with dyspnea, 18.03% (n = 163) with chest pain and a small proportion (12.94%, n = 117) with epigastric abdominal pain. Patients presenting with chest pain and a history of dyslipidemia were at a higher risk of developing acute coronary syndrome compared to the group without dyslipidemia (relative risk [RR] = 1.62 [1.01–2.58] P = 0.044). Diabetes and hypertension were the most prevalent chronic comorbidities in patients with dyspnea with a risk of (RR = 5.19 (0.68–39.27) P < 0.068). Patients who presented with epigastric pain and had a history of dyslipidemia had a risk of (RR = 5.23 (1.33–20.54) P = 0.009). Conclusion: The presenting symptoms should be taken into consideration by the emergency department physician to support the request for an Hs-TnI laboratory test. The yield and risk were both low in random screening.
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Kinsara et al. (2020) conducted a cohort in Emergency department patients with an Hs-TnI request (n=904). High-sensitivity troponin I (Hs-TnI) testing was evaluated on Acute coronary syndrome (ACS) in patients presenting with chest pain and dyslipidemia (RR 1.62, 95% CI 1.01-2.58, p=0.044). Patients presenting to the emergency department with chest pain and a history of dyslipidemia had a significantly higher risk of developing acute coronary syndrome compared to those without dyslipidemia (RR 1.62).
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