Patients discharged with elevated baseline high-sensitive cardiac troponin T from the emergency department
Christian Bjurman1, Matteus Zywczyk2, Soza Zangana2
1Department of Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Elevated high-sensitive cardiac troponin T (hs-cTnT) levels in emergency department patients indicate a higher risk of mortality. Current risk assessments are less effective for these individuals, necessitating improved strategies for managing suspected acute coronary syndrome.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarkers
Background:
- Elevated high-sensitive cardiac troponin T (hs-cTnT) is a significant predictor of poor outcomes in emergency department (ED) patients.
- Acute coronary syndrome (ACS) is a critical diagnosis in the ED, often relying on hs-cTnT levels for risk stratification.
Purpose of the Study:
- To evaluate the efficacy of an established ED risk assessment protocol in patients with suspected ACS and elevated baseline hs-cTnT.
- To identify potential limitations of current risk stratification in this specific patient subgroup.
Main Methods:
- An observational cohort study included 16,776 ED patients presenting with chest pain or dyspnea.
- hs-cTnT levels were analyzed at the time of ED visit; 1,480 patients with elevated levels (>14 ng/L) were discharged.
- Clinical, laboratory, and national health data were analyzed.
Main Results:
- While overall mortality was low (1.2% for discharged, 11% for admitted), elevated hs-cTnT levels (>14 ng/L) were a strong independent risk factor for 90-day mortality (HR 3.3) among discharged patients.
- Patients with hs-cTnT between 14-22 ng/L showed higher 90-day mortality whether discharged (4.1%) or admitted (6.7%).
- Risk assessment was less effective for patients with hs-cTnT levels between 14-22 ng/L compared to those triaged as high-risk.
Conclusions:
- The current ED risk assessment protocol demonstrates reduced effectiveness in patients with elevated hs-cTnT levels, particularly those with levels between 14-22 ng/L.
- Improved risk stratification strategies are needed for emergency department patients with suspected ACS and elevated hs-cTnT to optimize patient outcomes.
Background:
Elevated levels of high-sensitive cardiac troponin T (hs-cTnT) are linked to poor prognosis among emergency department (ED) patients.
Objective:
Examine the effect of our ED risk assessment among patients with suspected acute coronary syndrome (ACS) and elevated baseline hs-cTnT levels.
Design:
Observational cohort study of 16776 ED patients with chest pain or dyspnoea and a hs-cTnT sample analyzed at the time of the ED visit. Of these 1480 patients were sent home with elevated hs-cTnT levels (>14 ng/L).
Methods:
Analysis of clinical and laboratory data from the local hospital and data from the National Board of Health and Welfare.
Results:
Admitted patients had 11% and discharged patients had 1.2% 90-day mortality indicating effective risk assessment of patients with suspected ACS. However, if the suspected ACS patient presented with hs-cTnT between 14 and 22 ng/L, the 90-day mortality was 4.1% among discharged and 6.7% among admitted patients. Among discharged patients, an hs-cTnT level above 14 ng/L was a higher independent risk factor for 90-day mortality (HR 3.3, 95% CI 2.9-3.7, p < 0.001) than if the patient was triaged as a high-risk patient (HR 1.6, 95% CI 1.1-1.8, p < 0.001).
Conclusions:
Our ED risk assessment was less effective among patients presenting with elevated hs-cTnT levels.
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