Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study

Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study

Elevated high-sensitive cardiac troponin T
in emergency department patients: insights
from a retrospective descriptive cohort study

Abstract
Background High-sensitive cardiac troponin T (hs-cTnT) assessments are routinely conducted in German emergency
departments (EDs). However, data describing a large number of ED patients with pathological hs-cTnT levels and
subsequent clinical outcomes are limited.
Methods This retrospective descriptive analysis included 141.892 patients who presented to the interdisciplinary
ED at Klinikum rechts der Isar in Munich, Germany, between January 2019 and December 2021. Patients with trauma
diagnoses were excluded, focusing on those with elevated hs-cTnT levels. These patients were categorized into
three groups based on the International Classification of Procedures in Medicine (ICPM): those with elevated hs-cTnT
who received no coronary angiography (NCA), those who underwent diagnostic coronary angiography (DCA), and
those who received percutaneous coronary intervention (PCI). The objective of this study was to characterize a large
emergency department patient cohort and assess their subsequent clinical outcomes.
Results After initial Manchester Triage Sytem (MTS) categorization, 32.6% (46.307/141.892) of patients were identified
as non-trauma cases. Of these, 9.9% (4.587/46.307) had hs-cTnT levels exceeding 14 ng/L. Within this subset, 70.4%
(3.230/4.587) did not undergo coronary angiography, 15.4% (705/4.587) underwent DCA and 14.2% (652/4.587)
received PCI. Chest pain occurred more frequently in the PCI group (28.0%, 160/652) compared to the DCA group
(18.3%, 113/705) or NCA group (5.7%, 159/3230), p<0.001. However, breathing problems occurred more frequently
in the NCA group (23.2%, 647/3230) compared to the PCI group (17.7%, 101/652) or DCA group (21.8%, 135/705),
p<0.001. Also, collapse was more frequent in patients in the NCA group (4.0%, 112/3230) compared to the DCA
group (3.4%, 21/705) or PCI group (3.5%, 20/652), p<0.001. Overall, in-hospital mortality was significantly higher in the
NCA group (7.9%, 256/3230) compared to the DCA group (2.3%, 16/705) or PCI group (4.1%, 27/652), p<0.001.
Conclusion Emergency patients with elevated hs-cTnT who did not undergo coronary angiography faced a higher
risk of in-hospital mortality in our retrospective descriptive study. Given the heterogeneous nature of presenting
complaints in emergency departments, identifying at-risk patients can pose challenges for treating physicians.
Keywords Emergency department, High-sensitive troponin, Percutaneous coronary intervention

Finn Syryca1

, Bernhard Haller2

, Lisa Schmid3

, Christiane Kallweit3

, Philipp Nicol1

, Teresa Trenkwalder1

, Karl-
Georg Kanz3

, Anja Haas4
and Michael Dommasch3*

https://doi.org/10.1186/s12245-024-00735-w

2024

Peri Irawan

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