Key result
Stable low-level hsTnT after chest pain discharge is linked to a ~0.4% 30-day cardiac event rate.
Why the study?
The magnitude of risk and optimal management strategy for patients with low-level hsTn elevation ruled out for MI had not been extensively studied.
Does stable low-level hsTnT elevation predict adverse cardiac events in patients presenting with chest pain who rule out for MI and are discharged from the ED?
Cohort (n=4,396)
No
Does stable low-level hsTnT elevation predict adverse cardiac events in patients presenting with chest pain who rule out for MI and are discharged from the ED?
Absolute Event Rate: 0.4% vs 0.1%
p-value: p=0.041
Patients with stable low-level hsTnT elevation who rule out for MI and are discharged from the ED have very low 30-day adverse event rates, but significantly higher 1-year mortality and adverse events, suggesting a need for close outpatient follow-up.
Supports safe ED discharge after MI rule-out despite mild hsTnT elevation; leaves open optimal longer-term monitoring strategies.
BACKGROUND: The ideal high-sensitivity troponin (hsTn) cutoff for identifying those at low risk of 30 days events is debated; however, the 99th percentile overall or gender-specific upper reference limit (URL) is most commonly used. The magnitude of risk and the best management strategy for those with low-level hsTn elevation hasn't been extensively studied. METHODS: We conducted a retrospective cohort analysis including 4396 chest pain patients (542 with low-level hsTn elevation) who ruled out for myocardial infarction (MI), had a stable high-sensitivity troponin T (hsTnT) levels (defined as < 5 ng/l inter-measurements increase in hsTnT levels), and were discharged from the emergency department without further ischemic testing. The aim of the study was to compare the 30-day incidence of adverse cardiac events (ACE) between patients with undetectable high-sensitivity troponin T (hsTnT) (group 1), patients with hsTnT within the 99th percentile sex-specific URL (group 2), and patients with low-level hsTnT elevation (between the 99th percentile URL and ≤ 50 ng/l) (group 3). RESULTS: 30-day event rates were very low 0.1%, 0.6%, and 0.4% for hsTnT groups 1, 2, and 3 respectively (overall P = 0.041, for groups 2 & 3 interaction P = 0.74). 30-day all-cause mortality, as well as 1-year all-cause and cardiovascular mortalities, occurred more frequently in those with low-level hsTnT elevation as did 1-year composite ACE. CONCLUSION: In conclusion, 30-day adverse event rates were very low in those with stable low-level hsTnT elevation who ruled out for MI and were discharged from the emergency department without further inpatient testing.
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Mahmoud et al. (2020) conducted a cohort in Chest pain (n=4,396). Low-level hsTnT elevation (between 99th percentile URL and ≤ 50 ng/l) vs. Undetectable hsTnT or hsTnT within 99th percentile sex-specific URL was evaluated on 30-day incidence of adverse cardiac events (ACE) (p=0.041). Stable low-level hsTnT elevation in discharged chest pain patients had a very low 30-day adverse cardiac event rate (0.4%), compared to undetectable (0.1%) or normal (0.6%) levels (overall P=0.041).
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