Chief Complaint at Admission Relates to Troponin Level and Mortality in Patients With Non-ACS Troponin Elevation

BACKGROUND Elevated level of troponin T (TnT) in the absence of acute coronary syndrome (ACS) can be caused by a number of conditions but the relevance of the chief complaint at admission for TnT level and prognosis has not been reported previously. The aim was to study whether TnT level differs among chief complaints or underlying causes in patients with non-ACS TnT elevation and if these factors predict mortality. METHODS Patients admitted with TnT elevation were categorized as ACS or non-ACS and followed for 1 year. Statistical comparisons between different chief complaints and underlying causes were performed. RESULTS Patients with non-ACS TnT elevation (n = 71) were less likely to present with chest pain compared to ACS (n = 50) (37% vs. 74%, P < 0.001) whereas dyspnea (25%), syncope/arrhythmia (14%) or other chief complaints (24%) were more common. Patients with dyspnea and other chief complaints had higher peak values of TnT compared to chest pain (P < 0.05). The most common peak occurred within 3 hours after admission for chest pain, dyspnea and other chief complaints whereas for arrhythmia it occurred after 3 - 9 hours (P < 0.01). A peak value > 15 hours after admission was only observed among dyspnea and other chief complaints. Mortality was higher in patients presenting with dyspnea (50%) or other causes (35%) compared to chest pain (8%) or syncope/arrhythmia (10%) (P < 0.05). Renal failure was the only underlying cause that predicted mortality. CONCLUSION Among patients with non-ACS TnT elevation, patients presenting with dyspnea had higher TnT and higher 1-year mortality, whereas patients with chest pain were at lower risk.