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Disease Markers
Volume 2015 (2015), Article ID 157812, 6 pages
http://dx.doi.org/10.1155/2015/157812
Research Article

Diagnostic Implications of an Elevated Troponin in the Emergency Department

1Department of Emergency Medicine, Vanderbilt University, Nashville, TN 37232, USA
2Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
3Department of Biostatistics, Vanderbilt University, Nashville, TN 37203, USA
4Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA

Received 25 August 2014; Revised 12 December 2014; Accepted 30 January 2015

Academic Editor: Bertil Lindahl

Copyright © 2015 Maame Yaa Yiadom et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To determine the proportion of initial troponin (cTn) elevations associated with Type I MI versus other cardiovascular and noncardiovascular diagnoses in an emergency department (ED) and whether or not a relationship exists between the cTn level and the likelihood of Type I MI. Background. In the ED, cTn is used as a screening test for myocardial injury. However, the differential diagnosis for an initial positive cTn result is not clear. Methods. Hospital medical records were retrospectively reviewed for visits associated with an initial positive troponin I-ultra (cTnI), ≥0.05 μg/L. Elevated cTnI levels were stratified into low (0.05–0.09), medium (0.1–0.99), or high (≥1.0). Discharge diagnoses were classified into 3 diagnostic groups (Type I MI, other cardiovascular, or noncardiovascular). Results. Of 23,731 ED visits, 4,928 (21%) had cTnI testing. Of those tested, 16.3% had initial cTnI ≥0.05. Among those with elevated cTn, 11% were classified as Type I MI, 34% had other cardiovascular diagnoses, and 55% had a noncardiovascular diagnosis. Type I MI was more common with high cTnI levels (41% incidence) than among subjects with medium (9%) or low (6%). Conclusion. A positive cTn is most likely a noncardiovascular diagnosis, but Type I MI is far more common with cTnI levels ≥1.0.