Outcome of low-risk patients discharged home after a normal cardiac troponin I.
Patients with symptoms suggestive of, but at low risk for, acute coronary syndrome (ACS), who have a negative electrocardiogram (EKG) and a single normal troponin I at 6-9 h after symptom onset are frequently discharged from our Emergency Department (ED). We sought to determine their rate of adverse cardiac events at 30 days (ACE-30), defined as cardiac death or myocardial infarction (MI), by chart review, telephone interview, or county death records. Of 663 patients, data were available for 588 (89%). Mean age was 48 years; 59% were male. There were 390 patients (66%) who complained of chest pain. Previous coronary artery disease (CAD) was reported in 145 patients (25%). Two patients (0.34%) had ACE-30, both with non-ST elevation MI. There were no cases of cardiac death. None of the patients died in Hennepin County within 30 days. At our institution, low-risk patients with symptoms suggestive of ACS who are discharged home after a normal cTnI drawn 6-9 h after symptom onset have a very low incidence of cardiac events at 30 days.
Smith
Stephen W
SW
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota 55415, USA.
Tibbles
Carrie D
CD
Apple
Fred S
FS
Zimmerman
Marsha
M
D000789:Angina, Unstable / Q000175:diagnosis*; D002637:Chest Pain / Q000097:blood* / Q000209:etiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008910:Minnesota; D009203:Myocardial Infarction / Q000175:diagnosis*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D013577:Syndrome; D019210:Troponin I / Q000097:blood*
D019210:Troponin I