title: Prognostic usefulness of marginal troponin T elevation.
abstract: Marginal elevations of troponin T among patients with chest pain are often considered to be insignificant. We sought to define the prognostic value of marginal troponin T elevations in patients presenting to the emergency department with suspected myocardial ischemia. Four hundred twenty-eight consecutive patients presenting to the emergency department with ongoing chest pain were evaluated, followed through their hospital course, and contacted for follow-up 4 months after discharge. Two hundred ninety-nine patients had undetectable troponin T levels (<0.01 microg/L), 76 had marginal troponin T elevations (0.01 to 0.09 microg/L), and 53 had frank troponin T elevations (> or =0.1 microg/L). Patients with either marginally or frank elevated troponin levels were older and more likely to be men, but did not differ from patients with undetectable troponin levels with regard to the prevalence of coronary artery disease risk factors, history of coronary disease, or race. While in the hospital, the undetectable and marginal troponin groups were referred for cardiac testing in equal proportions (58% and 59%, respectively), whereas 87% of the elevated group underwent further testing. After adjustment for possible confounders, a significantly increased rate of death/myocardial infarction/revascularization was observed in the marginal troponin group compared with the undetectable troponin group (p = 0.004). Marginal elevations of troponin T identified a currently underevaluated high-risk subgroup of patients with suspected myocardial ischemia who are more likely to have adverse clinical outcomes than those with undetectable troponin levels.
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Eric E
authors.initials: EE
authors.lastname: Howell
authors.forename: David E
authors.initials: DE
authors.lastname: Bush
authors.forename: J Shawn
authors.initials: JS
authors.lastname: Miles
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Meininger
authors.forename: Tracy
authors.initials: T
authors.lastname: Friedlander
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Bushnell
authors.forename: Nisha
authors.initials: N
authors.lastname: Chandra-Strobos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T