Prognostic value of stable troponin T elevation in patients discharged from emergency department

Abstract

Troponin elevation in the absence of myocardial infarction is a challenging diagnostic problem in the emergency department (ED). Elevated troponin levels have a short-term negative prognostic value in critically ill patients hospitalized for all causes. No data are available about the short-term prognostic value of elevated troponin in ED patients discharged from hospital without clinical evidence of acute diseases. The aim of the study was to evaluate the short-term prognostic value of elevated stable troponin T (TnT) in ED patients discharged from hospital. Two hundred and thirty-two consecutive adult individuals admitted to ED evaluation for all causes, with TnT test and without evidence of acute diseases requiring hospitalization, were evaluated. The patients with TnT positive tests, without dynamic changes during in-hospital observation and discharged from hospital, were considered as case patients. For each case patient enrolled, the consecutive patient of the same sex and similar age, admitted to the ED on the same day and discharged with normal plasma TnT values, was enrolled as her/his control. The incidence of adverse clinical events in both cases and controls assessed by a phone call at 24 h, 7 days and 30 days after the ED discharge was recorded. Ninety-four cases and 94 controls were finally considered. The 30-day adverse events (death, hospitalization and ED access) were 35 of the 94 (37.2%) in cases and 18 of the 94 (19.1%) in controls (P < 0.01). The patients discharged from ED with stable elevated TnT levels, but without acute diseases, had a short-term prognosis worse than that of patients with similar clinical presentation but with normal TnT values.