• Am. J. Med. · Dec 2011

    Multicenter Study

    Patients with acute coronary syndrome and normal high-sensitivity troponin.

    • 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, and Christian Mueller.
    • Department of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland.
    • Am. J. Med. 2011 Dec 1;124(12):1151-7.

    BackgroundFailure 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.MethodsIn 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.ResultsACS 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).ConclusionAlmost 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.Copyright © 2011 Elsevier Inc. All rights reserved.

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