CARDIOVASCULAR MEDICINE

Risk stratification of patients with acute chest pain and normal troponin concentrations

J Sanchis, V Bodí, Á Llácer, J Núñez, L Consuegra, M J Bosch, V Bertomeu, V Ruiz and F J Chorro

Servei de Cardiologia, Hospital Clínic Universitari, Valencia, Spain

Correspondence to:
Correspondence to:
Dr J Sanchis
Servei de Cardiologia, Hospital Clínic Universitari, Blasco Ibáñez 17, 46010 Valencia, Spain; sanchis_juafor{at}gva.es

Objective: To investigate the outcome of patients with acute chest pain and normal troponin concentrations.

Design: Prospective cohort design.

Setting: Single centre study in a teaching hospital in Spain.

Patients: 609 consecutive patients with chest pain evaluated in the emergency department by clinical history (risk factors and a chest pain score according to pain characteristics), ECG, and early (< 24 hours) exercise testing for low risk patients with physical capacity (n = 283, 46%). All had normal troponin concentrations after serial determination.

Main outcome measures: Myocardial infarction or cardiac death during six months of follow up.

Results: 29 events were detected (4.8%). No patient with a negative early exercise test (n = 161) had events versus the 6.9% event rate in the remaining patients (p = 0.0001). Four independent predictors were found: chest pain score 11 points (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1 to 5.5, p = 0.04), diabetes mellitus (OR 2.3, 95% CI 1.1 to 4.7, p = 0.03), previous coronary surgery (OR 3.1, 95% CI 1.3 to 7.6, p = 0.01), and ST segment depression (OR 2.8, 95% CI 1.3 to 6.3, p = 0.003). A risk score proved useful for patient stratification according to the presence of 0–1 (2.7% event rate), 2 (10.2%, p = 0.008), and 3–4 predictors (29.2%, p = 0.0001).

Conclusions: A negative troponin result does not assure a good prognosis for patients coming to the emergency room with chest pain. Early exercise testing and clinical data should be carefully evaluated for risk stratification.

Keywords: prognosis; troponin; unstable angina

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This article has been cited by other articles:

• Sanchis, J, Bosch, X, Bodi, V, Bellera, N, Nunez, J, Benito, B, Ordonez, J, Consuegra, L, Heras, M, Llecer, A (2008). Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation. Heart 94: 311-315 [Abstract] [Full Text]  
• Swap, C. J., Nagurney, J. T. (2005). Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes. JAMA 294: 2623-2629 [Abstract] [Full Text]  

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Troponitis

Justin S Zaman

Online, 20 Jul 2005 [Full text]