Key result
Negative but measurable hs-cTn linked to ~260% higher 90-day CAG rate versus very low levels.
Why the study?
The clinical implications of negative but measurable high-sensitivity cardiac troponin levels in emergency department chest pain patients are not well understood.
Does a negative but measurable hs-cTn level (3-50 ng/L) predict worse clinical outcomes compared to very low levels (< 3 ng/L) in patients discharged from the ED with acute chest pain?
Cohort (n=23,297)
No
Does a negative but measurable hs-cTn level (3-50 ng/L) predict worse clinical outcomes compared to very low levels (< 3 ng/L) in patients discharged from the ED with acute chest pain?
Absolute Event Rate: 1.8% vs 0.5%
p-value: p=<0.001
In patients discharged from the ED with acute chest pain, negative but measurable hs-cTn levels (3-50 ng/L) are associated with significantly higher rates of subsequent coronary angiography, ED revisits, hospital admissions, and short-term mortality compared to very low levels (< 3 ng/L).
Measurable negative hs-cTn was associated with higher 90-day events; leaves open whether closer follow-up improves outcomes before practice change.
BACKGROUND: Chest pain is a common condition in the emergency department (ED). High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing acute coronary syndrome, but the implications of "negative but measurable" hs-cTn levels are not well understood. This study assesses the outcomes of patients with acute chest pain discharged from the ED based on their hs-cTn levels. METHODS: This retrospective cohort study analyzed medical records of patients aged 18 and older presenting with chest pain to the Tel Aviv Sourasky Medical Center ED from 2017 to 2022. We compared patients with negative but measurable hs-cTn levels (3-50 ng/L) to those with very low hs-cTn levels (< 3 ng/L). Primary outcomes included 90- days coronary angiogram (CAG), and secondary outcomes were 7- days ED revisits, 14-days hospital admissions, and 30- days mortality. RESULTS: Of 32,162 eligible patients, 23,297 had hs-cTn levels ≤ 50 ng/L. Patients with negative but measurable hs-cTn levels had higher rates of 90-days CAG (1.8% vs. 0.5%, p < 0.001), 7-day ED revisits (5.2% vs. 3.3%, p < 0.001), 14-day hospital admissions (3.1% vs. 0.9%, p < 0.001), and 30-day mortality (0.3% vs. 0.01%, p < 0.001) compared to those with very low hs-cTn levels. Independent predictors for 90 days CAG included age ≥ 57 years, male sex, and hs-cTn ≥ 3.5 ng/L. CONCLUSIONS: Negative but measurable hs-cTn levels are linked to worse outcomes than very low hs-cTn levels in discharged ED patients. Closer follow-up and further cardiac evaluation may be warranted for these patients.
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Greenberg et al. (2024) conducted a cohort in Acute chest pain (n=23,297). Negative but measurable hs-cTn levels (3-50 ng/L) vs. Very low hs-cTn levels (< 3 ng/L) was evaluated on 90-day coronary angiogram (CAG) (p=<0.001). Patients discharged from the emergency department with acute chest pain and negative but measurable hs-cTn levels (3-50 ng/L) had a significantly higher rate of 90-day coronary angiography compared to those with very low levels (1.8% vs. 0.5%, p<0.001).
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