title: High-sensitivity cardiac troponin T levels in the emergency department in patients with chest pain but no myocardial infarction.
abstract: BACKGROUND
  High-sensitivity cardiac troponin T (hs-cTnT) was recently introduced into clinical practice. The increased sensitivity has decreased the specificity. We aimed to determine the predictors for and prevalence of hs-cTnT levels above the 99th percentile in a stable population of patients without myocardial infarction (MI) who sought medical attention for chest pain in the emergency department.
  
  
  METHODS
  We included 11,847 patients with chest pain and at least one hs-cTnT measurement during 2011 and 2012. Patients with any acute reasons for an elevated hs-cTnT level were excluded. We used logistic regression to calculate adjusted odds ratios with 95% confidence intervals for the association between patient characteristics and hs-cTnT levels of >14ng/L. We also determined 50th, 75th, 97.5th, and 99th percentile values of hs-cTnT levels in relation to age, sex, estimated glomerular filtration rate (eGFR), and presence or absence of comorbidities.
  
  
  RESULTS
  In total, 1360 (11%) patients had hs-cTnT levels of >14ng/L. Men had higher troponin levels than women, and older patients had higher levels than younger patients. The strongest predictor of an elevated troponin level was a reduced eGFR. The 99th percentile for hs-cTnT among all men and among women <50years of age with normal renal function was 20 and 12ng/L, respectively; this level increased to 44 and 36ng/L, respectively, at the age of 70-79years.
  
  
  CONCLUSIONS
  A hs-cTnT level above the 99th percentile in patients with chest pain but no MI is common and is related to sex, age, and eGFR.
authors.affiliation: Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
authors.forename: Axel C
authors.initials: AC
authors.lastname: Carlsson
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bandstein
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Roos
authors.affiliation: Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Hammarsten
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden. Electronic address: martin.holzmann@karolinska.se.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Emergency department; High-sensitivity cardiac troponin T; No myocardial infarction; Normal level