Patients discharged with elevated baseline high-sensitive cardiac troponin T from the emergency department.

Biomarkers

Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Published: July 2021

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,  < 0.001) than if the patient was triaged as a high-risk patient (HR 1.6, 95% CI 1.1-1.8,  < 0.001).

Conclusions: Our ED risk assessment was less effective among patients presenting with elevated hs-cTnT levels.

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Source
http://dx.doi.org/10.1080/1354750X.2021.1917662DOI Listing

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