title: Risk stratification of patients with acute chest pain and normal troponin concentrations.
abstract: OBJECTIVE
  To investigate the outcome of patients with acute chest pain and normal troponin concentrations.
  
  
  METHODS
  Prospective cohort design.
  
  
  METHODS
  Single centre study in a teaching hospital in Spain.
  
  
  METHODS
  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.
  
  
  METHODS
  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 > or = 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.
authors: Servei de Cardiologia, Hospital Clínic Universitari, Valencia, Spain. sanchis_juafor@gva.es
authors: J
authors: J
authors: Sanchis
authors: V
authors: V
authors: Bodí
authors: A
authors: A
authors: Llácer
authors: J
authors: J
authors: Núñez
authors: L
authors: L
authors: Consuegra
authors: M J
authors: MJ
authors: Bosch
authors: V
authors: V
authors: Bertomeu
authors: V
authors: V
authors: Ruiz
authors: F J
authors: FJ
authors: Chorro
mesh_terms: D000208:Acute Disease; D002637:Chest Pain / Q000097:blood / Q000209:etiology* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005080:Exercise Test; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology*; D011379:Prognosis; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I