Abstract
Objectives
Elevated cardiac troponin is not uncommon in patients visiting emergency department (ED) even without coronary artery disease, but its prognostic implication is not well understood in such patients.
Methods
In this retrospective single-center registry, we investigated clinical outcome of patients visiting ED without documented coronary artery disease. Patients were categorized according to the maximal value of Siemens ADVIA Centaur TnI-Ultra assay (TnI) within 24 h after visit. Primary endpoint was 180-day all-cause death that included cardiac and non-cardiac death.
Results
A total of 35,205 patients with median age 61 years and male gender 54.7% were included. Below the lowest level of detection (LOD) (≤0.006 ng/mL), between LOD and assay-specific <99th percentile (0.007–0.039 ng/mL), below median of ≥99th percentile (0.040–0.149 ng/mL), and above median of ≥99th percentile (≥0.150 ng/mL) TnI were found in 18,502 (52.6%), 11,338 (32.2%), 3,029 (8.6%), and 2,336 (6.6%) patients. In the 180-day follow-up period, 4,341 (12.3%) all-cause death including 694 (2.0%) cardiovascular death and 3,647 (10.4%) non-cardiovascular death developed. The risks of all-cause, cardiovascular, and non-cardiovascular death increased across higher TnI strata (hazard ratio [HR]=1.3 to 2.4; 2.0 to 9.3; 1.3 to 1.7; p<0.001, all). Analyses of multivariate models showed consistent results.
Conclusions
In patients visiting ED, elevated TnI was associated with higher risk of 180-day cardiovascular and non-cardiovascular death. Patients with elevated TnI may need additional evaluation or careful follow-up even without primary diagnosis of coronary artery disease.
Funding source: Ministry of Trade Industry & Energy, Ministry of Science & ICT, Ministry of Health and Welfare under Technology Development Program for Ai-Bio-Robot-Medicine Convergence
Award Identifier / Grant number: 20001704
Funding source: National Research Foundation of Korea
Award Identifier / Grant number: 2017R1A2B310918
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Research funding: This study was supported by National Research Foundation of Korea (#2017R1A2B310918) and Ministry of Trade Industry & Energy, Ministry of Science & ICT, Ministry of Health and Welfare under Technology Development Program for Ai-Bio-Robot-Medicine Convergence (20001704).
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Author contributions: All authors had access to the data and a role in writing the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was waived given the retrospective design, the use of anonymized big database, and the reporting of aggregated results.
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Ethical approval: The Samsung Medical Center Institutional Review Board approved this study.
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-1392).
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