Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels
Abstract Background Chest pain is a common condition in the emergency department (ED). High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing acute coronary syndrome, but the implications of “negative but measurable” hs-cTn levels are not well understood. This study assesses th...
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BMC
2024-11-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-024-01128-1 |
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| author | Sharon A. Greenberg Neta Cohen Noa Shopen Reut Aviv Mordechai David Zeltser Julieta Werthein |
| author_facet | Sharon A. Greenberg Neta Cohen Noa Shopen Reut Aviv Mordechai David Zeltser Julieta Werthein |
| author_sort | Sharon A. Greenberg |
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| description | Abstract Background Chest pain is a common condition in the emergency department (ED). High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing acute coronary syndrome, but the implications of “negative but measurable” hs-cTn levels are not well understood. This study assesses the outcomes of patients with acute chest pain discharged from the ED based on their hs-cTn levels. Methods This retrospective cohort study analyzed medical records of patients aged 18 and older presenting with chest pain to the Tel Aviv Sourasky Medical Center ED from 2017 to 2022. We compared patients with negative but measurable hs-cTn levels (3–50 ng/L) to those with very low hs-cTn levels (< 3 ng/L). Primary outcomes included 90- days coronary angiogram (CAG), and secondary outcomes were 7- days ED revisits, 14-days hospital admissions, and 30- days mortality. Results Of 32,162 eligible patients, 23,297 had hs-cTn levels ≤ 50 ng/L. Patients with negative but measurable hs-cTn levels had higher rates of 90-days CAG (1.8% vs. 0.5%, p < 0.001), 7-day ED revisits (5.2% vs. 3.3%, p < 0.001), 14-day hospital admissions (3.1% vs. 0.9%, p < 0.001), and 30-day mortality (0.3% vs. 0.01%, p < 0.001) compared to those with very low hs-cTn levels. Independent predictors for 90 days CAG included age ≥ 57 years, male sex, and hs-cTn ≥ 3.5 ng/L. Conclusions Negative but measurable hs-cTn levels are linked to worse outcomes than very low hs-cTn levels in discharged ED patients. Closer follow-up and further cardiac evaluation may be warranted for these patients. |
| format | Article |
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| issn | 1471-227X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | BMC Emergency Medicine |
| spelling | doaj-art-51f9305aeeae48968acb4dae8a5dd0b62025-08-20T02:08:19ZengBMCBMC Emergency Medicine1471-227X2024-11-012411810.1186/s12873-024-01128-1Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levelsSharon A. Greenberg0Neta Cohen1Noa Shopen2Reut Aviv Mordechai3David Zeltser4Julieta Werthein5Emergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University Faculty of MedicinePediatric Emergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University Faculty of MedicineEmergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University Faculty of MedicineEmergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University Faculty of MedicineEmergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University Faculty of MedicineEmergency Medicine Department, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University Faculty of MedicineAbstract Background Chest pain is a common condition in the emergency department (ED). High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing acute coronary syndrome, but the implications of “negative but measurable” hs-cTn levels are not well understood. This study assesses the outcomes of patients with acute chest pain discharged from the ED based on their hs-cTn levels. Methods This retrospective cohort study analyzed medical records of patients aged 18 and older presenting with chest pain to the Tel Aviv Sourasky Medical Center ED from 2017 to 2022. We compared patients with negative but measurable hs-cTn levels (3–50 ng/L) to those with very low hs-cTn levels (< 3 ng/L). Primary outcomes included 90- days coronary angiogram (CAG), and secondary outcomes were 7- days ED revisits, 14-days hospital admissions, and 30- days mortality. Results Of 32,162 eligible patients, 23,297 had hs-cTn levels ≤ 50 ng/L. Patients with negative but measurable hs-cTn levels had higher rates of 90-days CAG (1.8% vs. 0.5%, p < 0.001), 7-day ED revisits (5.2% vs. 3.3%, p < 0.001), 14-day hospital admissions (3.1% vs. 0.9%, p < 0.001), and 30-day mortality (0.3% vs. 0.01%, p < 0.001) compared to those with very low hs-cTn levels. Independent predictors for 90 days CAG included age ≥ 57 years, male sex, and hs-cTn ≥ 3.5 ng/L. Conclusions Negative but measurable hs-cTn levels are linked to worse outcomes than very low hs-cTn levels in discharged ED patients. Closer follow-up and further cardiac evaluation may be warranted for these patients.https://doi.org/10.1186/s12873-024-01128-1ED dischargeChest painTroponinOutcomes after discharge |
| spellingShingle | Sharon A. Greenberg Neta Cohen Noa Shopen Reut Aviv Mordechai David Zeltser Julieta Werthein Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels BMC Emergency Medicine ED discharge Chest pain Troponin Outcomes after discharge |
| title | Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels |
| title_full | Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels |
| title_fullStr | Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels |
| title_full_unstemmed | Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels |
| title_short | Outcomes of ED chest pain visits: the prognostic value of negative but measurable high-sensitivity cardiac troponin (hs-cTn) levels |
| title_sort | outcomes of ed chest pain visits the prognostic value of negative but measurable high sensitivity cardiac troponin hs ctn levels |
| topic | ED discharge Chest pain Troponin Outcomes after discharge |
| url | https://doi.org/10.1186/s12873-024-01128-1 |
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