Key result
Among young adults presenting to the ED with chest pain and elevated troponin I, 32.7% were diagnosed with myocardial infarction and 59.2% with myocarditis.
Observational (n=49)
No
In young adults under 40 presenting with chest pain and elevated troponin, myocardial infarction is present in about one-third of cases and can be distinguished from myocarditis by older age, cardiovascular risk factors, and the absence of recent viral illness.
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Highlights myocarditis predominance among young adults with chest pain and troponin elevation; leaves open validated differentiation algorithms for prospective testing.
OBJECTIVES: To evaluate the prevalence and clinical presentation of myocardial infarction (MI) and myocarditis in young adults presenting with chest pain (CP) and an elevated serum troponin I (TnI) to the emergency department (ED). DESIGN: Retrospective, observational, single-centre study. PARTICIPANTS: All consecutive patients 18-40 years old admitted to the ED for CP with an elevated TnI concentration. PRIMARY OUTCOME MEASURES: Prevalence of MI, myocarditis and the characterisation of clinical presentation. RESULTS: 1588 patients between 18 and 40 years old were admitted to the ED with CP during 30 consecutive months. 49 (3.1%) patients with an elevated TnI (>0.09 μg/l) were included. 32.7% (16/49) were diagnosed with MI (11 ST-elevation myocardial infarction (STEMI) and 5 non-ST-elevation myocardial infarction (NSTEMI)) and 59.2% (29/49) with myocarditis. Compared with patients with myocarditis, MI patients were older (34.1±3.8 vs 26.9±6.4, p=0.0002) with more cardiovascular risk factors (mean 2.06 vs 0.69). Diabetes (18.8% vs 0%, p=0.0039), dyslipidaemia (56.2% vs 3.4%, p<0.0001) and family history of coronary artery disease (CAD) (37.5% vs 10.3% p=0.050) were associated with MI. Fever or recent viral illness were present in 75.9% (22/29) of patients with myocarditis, and in 0% of MI patients (p<0.0001). During follow-up, two patients with myocarditis were re-admitted for CP. CONCLUSIONS: In this study, 32.7% of patients <40-year-old admitted to an ED with CP and elevated TnI had a diagnosis of MI. Key distinctive clinical factors include diabetes, dyslipidaemia, family history of CAD and fever or recent viral illness.
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Pellaton et al. (2012) conducted an observational in Chest pain with elevated serum troponin I (n=49). Myocardial infarction vs. Myocarditis was evaluated on Prevalence of MI, myocarditis and the characterisation of clinical presentation. Among young adults presenting to the ED with chest pain and elevated troponin I, 32.7% were diagnosed with myocardial infarction and 59.2% with myocarditis.
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