title: The clinical relevance of raised cardiac troponin I in the absence of significant angiographic coronary artery disease.
abstract: OBJECTIVE
  Cardiac troponins are highly sensitive and specific markers of myocardial cell injury. We wished to determine the clinical relevance of raised troponins in the absence of significant angiographic coronary artery disease.
  
  
  METHODS
  We assessed patients admitted to our hospital over the past 3 years with troponin-positive chest pain and no angiographically significant coronary disease.
  
  
  RESULTS
  The study included 67 patients, all of whom had symptoms of "chest pain" and elevated (>0.2 microg/L) troponin I on admission. Thirty-four (51%) patients had alternative causes for myocyte injury other than coronary ischaemia. In the remaining 33 (49%) patients we could find no other associated features or diagnoses. Follow up was obtained in 29 (88%) of these 33 patients (mean follow up 58+/-13 weeks, range 17-156 weeks). During the follow up period, three (4.5%) patients were readmitted with further ischaemic events.
  
  
  CONCLUSIONS
  Myocardial damage can occur in the absence of significant angiographic coronary disease and other causes of raised troponins should be considered according to the clinical presentation. Troponin-positive cases with angiographically "normal" coronary arteries can re-present with future cardiac events and should still be considered for aggressive risk management.
authors.affiliation: Department of Cardiology, King's College Hospital, Denmark Hill, London, UK. tmageh@hotmail.com
authors.forename: Thuraia
authors.initials: T
authors.lastname: Nageh
authors.forename: Roy A
authors.initials: RA
authors.lastname: Sherwood
authors.forename: Ray J
authors.initials: RJ
authors.lastname: Wainwright
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D009202:Cardiomyopathies / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I