Validation of high-sensitivity troponin I levels for major adverse cardiac events in low risk chest pain patients

¹Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
²Department of Emergency Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea

Correspondence

Ha Young Park ,Tel: 051-797-0131, Fax: 051-797-0034, Email: cprrosc@gmail.com,

Received: October 9, 2022; Revised: November 2, 2022 Accepted: November 3, 2022. Published online: December 31, 2023.

ABSTRACT

Objective:
This study examined whether the efficiency of the level of detection (LOD) and upper reference limit (URL) for high-sensitivity cardiac troponin I (hs-cTnI) is increased when major adverse cardiovascular events (MACEs) occur in patients with low-risk chest pain who visit the emergency department (ED) and how long they stay in the ED.
Method:
The URL for hs-cTnI used in the hospital improved from 0.04 ng/mL (LOD <0.0041 ng/mL) in 2018 to 19.8 pg/mL (LOD <2.3 pg/mL) in 2019. In these two years, the occurrence of MACEs, frequency of hs-cTnI follow-up in the ER, and the length of stay in the ER were compared. In addition, the three calculated risk assessment scores for the safety level of early discharge were compared.
Results:
In 2018, there were six MACEs out of 120 patients (5.0%), no cardiac deaths, one acute myocardial infarction (AMI), and five unplanned coronary revascularizations. In 2019, six MACEs out of 105 patients (5.7%) were all unplanned coronary revascularizations without any cardiac deaths or AMIs.
Conclusion:
Although the level of hs-cTnI measurement was improved, there was no difference in the incidence of MACEs in patients with low-risk chest pain who were discharged from the ED, and the number of hs-cTnI follow-ups and time in the ED increased. Interestingly, there were only short-term MACEs and no medium-term MACEs. In addition, there was little to no coronary artery occlusion disease. The risk assessment score combined with hs-cTnI improved the predictive performance for MACEs.

Key words: Troponin I; Acute coronary syndrome; Chest pain