Prognosis is worse with elevated cardiac troponin in nonacute coronary syndrome compared with acute coronary syndrome

Yu Horiuchi, Nicholas Wettersten, Mitul P. Patel, Christian Mueller, Sean Xavier Neath, Robert H. Christenson, Nils G. Morgenthaler, James McCord, Richard M. Nowak, Gary M. Vilke, Lori B. Daniels, Judd E. Hollander, Fred S. Apple, Chad M. Cannon, John T. Nagurney, Donald Schreiber, Christopher Defilippi, Christopher Hogan, Deborah B. Diercks, Gary HeaddenAlexander T. Limkakeng, Inder Anand, Alan H.B. Wu, Stefan Ebmeyer, Allan S. Jaffe, W. Frank Peacock, Alan Maisel

Research output: Contribution to journalArticlepeer-review

Abstract

Background Cardiac troponin (cTn) can be elevated in many patients presenting to the emergency department (ED) with chest pain but without a diagnosis of acute coronary syndrome (ACS). We compared the prognostic significance of cTn in these different populations. Methods We retrospectively analyzed the CHOPIN study, which enrolled patients who presented to the ED with chest pain. Patients were grouped as ACS, non-ACS cardiovascular disease, noncardiac chest pain and chest pain not otherwise specified (NOS). We examined the prognostic ability of cTnI for the clinical endpoints of mortality and major adverse cardiovascular event (MACE; a composite of acute myocardial infarction, unstable angina, revascularization, reinfarction, and congestive heart failure and stroke) at 180-day follow-up. Results Among 1982 patients analyzed, 14% had ACS, 21% had non-ACS cardiovascular disease, 31% had a noncardiac diagnosis and 34% had chest pain NOS. cTnI elevation above the 99th percentile was observed in 52, 18, 6 and 7% in these groups, respectively. cTnI elevation was associated with mortality and MACE, and their relationships were more prominent in noncardiac diagnosis and chest pain NOS than in ACS and non-ACS cardiovascular diagnoses for mortality, and in non-ACS patients than in ACS patients for MACE (hazard ratio for doubling of cTnI 1.85, 2.05, 8.26 and 4.14, respectively; P for interaction 0.011 for mortality; 1.04, 1.23, 1.54 and 1.42, respectively; P for interaction <0.001 for MACE). Conclusion In patients presenting to the ED with chest pain, cTnI elevation was associated with a worse prognosis in non-ACS patients than in ACS patients.

Original languageEnglish (US)
Pages (from-to)376-384
Number of pages9
JournalCoronary artery disease
Volume33
Issue number5
DOIs
StatePublished - Aug 1 2022

Keywords

  • acute coronary syndrome
  • cardiac troponin
  • chest pain
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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