Kinetic changes in high-sensitivity cardiac troponin for risk stratification of emergency department chest pain patients

Abstract

Objective

Kinetic patterns of high-sensitivity cardiac troponin I (hs-cTnI) levels may provide prognostic value in chest pain patients. This study aimed to evaluate the association between these patterns and 30-day major adverse cardiac events (MACE).

Methods

A retrospective observational study was conducted, involving Emergency Department (ED) chest pain patients with at least two serial hs-cTnI measurements during their ED stay. Patients were categorized into three groups based on their hs-cTnI kinetic patterns: no change (delta hs-cTnI ≤15 ng/L), rising pattern (RP, delta hs-cTnI>15 ng/L), and falling pattern (FP, delta hs-cTnI>15 ng/L). Thirty-day MACE outcomes were compared across these groups. A stepwise multivariable logistic regression was utilized to evaluate the association of hs-cTnI patterns with 30-day MACE.

Results

This study included 4243 patients. No changes in hs-cTnI were observed in 3777 patients, with 136 (3.6 %) experiencing 30-day MACE. RP was identified in 294 patients, of whom 101 (34.4 %) experienced 30-day MACE, while FP was observed in 172 patients, with 25 (14.5 %) experiencing 30-day MACE. After adjusting for potential confounders, the adjusted odds ratio (AOR) for RP associated with 30-day MACE was 7.68 (95 % CI 5.34–11.05, p < 0.001) and the AOR for FP associated with 30-day MACE was 1.99 (95 % CI 1.14–3.48, p = 0.016).

Conclusions

Serial hs-cTnI measurements are valuable for identifying patients at risk for 30-day MACE, as both a RP and a FP in hs-cTnI levels are associated with a significantly increased risk of 30-day MACE.