Most Emergency Department Patients with Troponin Elevation Do Not Have Acute Coronary Syndromes

A simple chart review demonstrates that elevated troponin usually results from causes other than coronary occlusion.

Mild troponin elevations are common in the absence of coronary occlusion. To determine the proportion of troponin elevations that are due to coronary occlusion, investigators at a single center searched laboratory records to identify all cases of troponin I ≥0.06 ng/mL during 2013 to 2014. The investigators then reviewed charts for a random sample of 458 (35%) of these cases to determine whether the inpatient team (cardiologists and hospitalists) attributed the troponin rise to acute coronary syndrome (ACS) or another cause.

The troponin elevation was not due to ACS in 79% of cases. The first positive troponin measurement was much higher in ST-elevation myocardial infarction (STEMI) cases than in non-STEMI cases and non-ACS cases (median, 10…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Most Emergency Department Patients with Troponin Elevation Do Not Have Acute Coronary Syndromes

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Reviewing Author