Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry.
OBJECTIVE
The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated.


BACKGROUND
Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS).


METHODS
A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed.


RESULTS
A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7 %) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0 %. In contrast, 605 patients (27.3 %) underwent a coronary angiography without revascularization and had an ACS in 79.8 %. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4 %), pericarditis/myocarditis (4.5 %), decompensated congestive heart failure (3.7 %), Takotsubo cardiomyopathy (2.7 %), hypertensive crisis (2.4 %), and pulmonary embolism (0.3 %). During the 3-month followup, patients without revascularization had a higher mortality (12.1 vs. 4.5 %, p<0.0001) representing the major contributor to the higher rate of MACCE (15.1 vs. 8.1 %, p<0.001). These data were confirmed in a subgroup analysis of ACS patients with or without revascularization.


CONCLUSIONS
Patients presenting to a CPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted.
Alexander
A
Illmann
Thomas
T
Riemer
Raimund
R
Erbel
Evangelos
E
Giannitsis
Christian
C
Hamm
Michael
M
Haude
Gerd
G
Heusch
Lars S
LS
Maier
Thomas
T
Münzel
Claus
C
Schmitt
Burghard
B
Schumacher
Jochen
J
Senges
Thomas
T
Voigtländer
Harald
H
Mudra
D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003325:Coronary Care Units; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*; D015854:Up-Regulation
D015415:Biomarkers; D014336:Troponin