Risk stratification of patients with acute chest pain and normal troponin concentrations.
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.
Sanchis
J
J
Servei de Cardiologia, Hospital Clínic Universitari, Valencia, Spain. sanchis_juafor@gva.es
Bodí
V
V
Llácer
A
A
Núñez
J
J
Consuegra
L
L
Bosch
M J
MJ
Bertomeu
V
V
Ruiz
V
V
Chorro
F J
FJ
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*
D019210:Troponin I