Risk factors related to in-hospital mortality in patients with nontraumatic myocardial injury presenting to the emergency department

Lee, Dowon; Jung, Haewon; Ryoo, Hyun Wook; Ahn, Jae Yun; Moon, Sungbae; Seo, Kang Suk; Park, Jungbae

J Korean Soc Emerg Med > Volume 37(1); 2026 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2026;37(1): 10-19.

Risk factors related to in-hospital mortality in patients with nontraumatic myocardial injury presenting to the emergency department

Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence

Haewon Jung ,Tel: 053-420-6400, Fax: 053-428-2820, Email: haewon@knu.ac.kr,

Received: July 4, 2025; Revised: October 7, 2025 Accepted: December 6, 2025. Published online: February 28, 2026.

ABSTRACT

Objective:
To identify clinical factors associated with in-hospital mortality among patients presenting to the emergency department (ED) with nontraumatic myocardial injury.
Methods:
This retrospective observational study included adult patients who visited a single ED from January to December 2022 and had elevated high-sensitive troponin I levels above the 99th percentile. Patients with trauma, cardiac arrest, transfers, or do-not-resuscitate status were excluded. Data on the demographics, vital signs, mental status, comorbidities, and final ED diagnoses were analyzed using multivariable logistic regression analysis.
Results:
Among 989 patients, 117 (11.8%) died during hospitalization. The respiratory rate ≥25/min (adjusted odds ratio [aOR], 5.39; 95% confidence interval [CI], 1.65-6.59), respiratory rate 21-24/min (aOR, 3.30; 95% CI, 2.64-11.02), and SpO2 <91% (aOR, 5.47; 95% CI, 2.73-10.95) were significantly associated with mortality. Comorbidities, including coronary artery disease (aOR, 2.78; 95% CI, 1.47-5.26), respiratory disease (aOR, 2.89; 95% CI, 1.18-7.15), and malignancy (aOR, 2.91; 95% CI, 1.18-7.15), were also independent predictors. Compared to a type 1 myocardial infarction, the final ED diagnoses of infectious diseases (aOR, 31.88; 95% CI, 11.59-87.72), neoplasms (aOR, 6.71; 95% CI, 2.51-17.94), and cerebrovascular diseases (aOR, 4.76; 95% CI, 1.75-11.46) were associated with higher mortality.
Conclusion:
In patients with nontraumatic myocardial injury presenting to the ED, respiratory abnormalities, coronary artery diseases, respiratory diseases and malignancy were independently associated with in-hospital mortality, while final ED diagnoses of infection, neoplasm, and cerebrovascular disease were associated with a higher risk of mortality compared to type 1 myocardial infarction.

Key words: Troponin I; Hospital mortality; Hospital emergency service; Triage