title: Outcomes of hospitalized patients with non-acute coronary syndrome and elevated cardiac troponin level.
abstract: OBJECTIVE
  Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome. Although cardiac troponin levels may be elevated in patients presenting with non-acute coronary syndrome conditions, specific diagnoses and long-term outcomes within that cohort are unclear.
  
  
  METHODS
  By using the Veterans Affairs centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, primary diagnoses were categorized as acute coronary syndrome or non-acute coronary syndrome conditions.
  
  
  RESULTS
  Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2%) had a non-acute coronary syndrome condition. Among that cohort, the most common diagnostic category involved the cardiovascular system, and congestive heart failure (N=1661) and chronic coronary artery disease (N=1648) accounted for the major classifications. At 1 year after hospital discharge, mortality in patients with a non-acute coronary syndrome condition was 22.8% and was higher than in the acute coronary syndrome cohort (odds ratio 1.39; 95% confidence interval, 1.30-1.49). Despite the high prevalence of cardiovascular diseases in patients with a non-acute coronary syndrome diagnosis, use of cardiac imaging within 90 days of hospitalization was low compared with that in patients with acute coronary syndrome (odds ratio 0.25; 95% confidence interval, 0.23-0.27).
  
  
  CONCLUSIONS
  Hospitalized patients with an elevated troponin level more often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets before hospital discharge.
authors: Cardiology Section, Veterans Affairs Medical Center, Minneapolis, Minn. 55417, USA. mcfal00l@umn.edu
authors: Edward O
authors: EO
authors: McFalls
authors: Greg
authors: G
authors: Larsen
authors: Gary R
authors: GR
authors: Johnson
authors: Fred S
authors: FS
authors: Apple
authors: Steven
authors: S
authors: Goldman
authors: Andrew
authors: A
authors: Arai
authors: Brahmajee K
authors: BK
authors: Nallamothu
authors: Robert
authors: R
authors: Jesse
authors: Scott T
authors: ST
authors: Holmstrom
authors: Patricia L
authors: PL
authors: Sinnott
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