Abstract | BACKGROUND: Failure 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. METHODS: In 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. RESULTS: ACS 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). CONCLUSION: Almost 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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Authors | Christophe Meune, Cathrin Balmelli, Raphael Twerenbold, Tobias Reichlin, Miriam Reiter, Philip Haaf, Stephan Steuer, Stefano Bassetti, Konstantin Sakarikos, Isabel Campodarve, Christa Zellweger, Affan Irfan, Beatrice Drexler, Christian Mueller |
Journal | The American journal of medicine
(Am J Med)
Vol. 124
Issue 12
Pg. 1151-7
(Dec 2011)
ISSN: 1555-7162 [Electronic] United States |
PMID | 22014790
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2011 Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Acute Coronary Syndrome
(blood, diagnosis, mortality)
- Aged
- Aged, 80 and over
- Biomarkers
(blood)
- Chi-Square Distribution
- Diagnosis, Differential
- Electrocardiography
- Female
- Follow-Up Studies
- Humans
- Logistic Models
- Male
- Middle Aged
- Prospective Studies
- Risk Factors
- Statistics, Nonparametric
- Troponin
(blood)
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