J Korean Soc Emerg Med.  2023 Dec;34(6):586-598.

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

• Ryu HJ
• Park HY
• Hwang TS
• Kim HB
• Lee JH

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.
Methods
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.

Keyword

Troponin I; Acute coronary syndrome; Chest pain