Patients with acute coronary syndrome and normal high-sensitivity troponin |
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Authors: | Meune Christophe Balmelli Cathrin Twerenbold Raphael Reichlin Tobias Reiter Miriam Haaf Philip Steuer Stephan Bassetti Stefano Sakarikos Konstantin Campodarve Isabel Zellweger Christa Irfan Affan Drexler Beatrice Mueller Christian |
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Affiliation: | aDepartment of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland;bParis Descartes University, Cardiology Department, Cochin Hospital, APHP, Paris, France;cEmergency Department, Spital Lachen, Lachen, Switzerland;dDepartment of Internal Medicine, Kantonsspital Olten, Olten, Switzerland;eServicio de Pneumologia, Hospital del Mar - IMIM, UPF, CIBERES, ISC III, Barcelona, Spain;fServicio de Urgencias, Hospital del Mar - IMIM, UPF, CIBERES, ISC III, Barcelona, Spain |
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Abstract: | BackgroundFailure to identify patients with acute coronary syndrome (ACS) is a serious clinical problem. The incidence, characteristics, and outcome of ACS patients with normal high-sensitivity cardiac troponin T (hs-cTnT) levels at presentation are unknown.MethodsIn a prospective multicenter study, hs-cTnT was determined in a blinded fashion in 1181 consecutive patients presenting with acute chest pain to the emergency department. The final diagnosis of ACS was adjudicated by 2 independent cardiologists. Patients were followed for 12 months.ResultsACS was the adjudicated diagnosis in 351 patients (30%), including 187 patients with acute myocardial infarction (AMI) and 164 patients with unstable angina (UA). At presentation, hs-cTnT was normal (<.014 ug/L) in 112 ACS patients (32%), including 11 patients (6%) with AMI and 101 patients (62%) with UA (P <.001). Multivariable analysis revealed previous statin treatment, younger age, preserved renal function, and the absence of ST deviation on the electrocardiogram as independently associated with normal hs-cTnT levels. Mortality rates in ACS patients with normal hs-cTnT level were 0.0% at 30 days, 0.0% at 90 days, and 2.0% (95% confidence interval, 0.5-7.9) at 360 days, which was significantly lower than in ACS patients with elevated hs-cTnT level at presentation (17.5% at 360 days, P <.001). Conversely, AMI rates at 360 days was higher in ACS patients with normal versus elevated hs-cTnT levels (P = .004).ConclusionAlmost one third of ACS patients have normal hs-cTnT levels at presentation, mostly patients with UA. ACS patients with normal hs-cTnT have a very low mortality, but an increased rate of AMI during the subsequent 360 days. |
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Keywords: | Acute coronary syndrome False negative High-sensitivity troponin Prognosis |
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