title: Investigations, findings, and follow-up in patients with chest pain and elevated high-sensitivity cardiac troponin T levels but no myocardial infarction.
abstract: BACKGROUND
  Elevated troponin levels, in patients without myocardial infarction (MI), are associated with increased mortality. In an observational cohort study we aimed to assess how patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) levels, and no MI are investigated and followed up, compared to patients with MI.
  
  
  METHODS
  During January 1, 2011 to December 31, 2012, all patients >25years of age, with chest pain and elevated hs-cTnT levels or MI, at the Karolinska University Hospital were included. We calculated risk ratios (RR) with 95% confidence intervals (CI) for echocardiographies, stress tests, and follow-up, and compared medication in patients with and without MI.
  
  
  RESULTS
  1848 patients with elevated hs-cTnT levels but no MI, of whom 871 (47%) had no prior heart disease, and 667 patients with MI were included. Echocardiography was performed in 609 patients (33%) without MI and 580 (87%) with MI (adjusted RR 0.42; 95% CI, 0.37-0.48). Follow-up was planned for 856 (46%) patients without MI and 611 (92%) with MI (adjusted RR 0.54; 95% CI, 0.48-0.60). Among patients without MI and no heart disease who underwent echocardiography 46 (14%) had a left ventricular ejection fraction of ≤40%, and on stress tests 27 (37%) had findings associated with ischemia. Platelet inhibitors and statins were started in 266 (25%) and 199 (17%) patients without MI, respectively, compared with 424 (93%), and 416 (86%) patients with MI.
  
  
  CONCLUSIONS
  Patients with elevated hs-cTnT levels and no MI are rarely investigated for detection of cardiac disease or followed up, or started on cardiovascular medication that potentially could prevent future cardiovascular events and death.
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Roos
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anton
authors.initials: A
authors.lastname: Hellgren
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Internal Medicine, NYU Lutheran Medical Center, Brooklyn, NY, USA.
authors.forename: Farshid
authors.initials: F
authors.lastname: Rafatnia
authors.affiliation: Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Hammarsten
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Ljung
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 Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: martin.holzmann@karolinska.se.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; 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