CLINICAL STUDIES
Cardiac troponin I as a predictor of major cardiac events in emergency department patients with acute chest pain
Carísi A. Polanczyk, MD, MScb,
Thomas H. Lee, MD, MSc, FACCa,
E. Francis Cook, ScDa,
Ron Walls, MDc,
Donald Wybenga, MDd,
Gail Printy-Klein, RNa,
Lynn Ludwig, RNa,
Gretchen Guldbrandsen, BAa and
Paula A. Johnson, MD, MPHa
a Section for Clinical Epidemiology, Division of General Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
b Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
c Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
d Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
Manuscript received October 3, 1997;
revised manuscript received January 26, 1998,
accepted March 16, 1998.
Address for correspondence: Dr. Thomas H. Lee, Partners Community HealthCare, Inc., Suite 1150, Prudential Tower/Boston, Massachusetts 02119
thlee{at}partners.org
Objectives. We sought to evaluate the diagnostic and prognostic value of cardiac troponin I (cTnI) in emergency department (ED) patients with chest pain.
Background. Although cTnI has been shown to correlate with an increased risk for complications in patients with unstable angina, the prognostic significance of this assay in the heterogeneous population of patients who present to the ED with chest pain is unclear.
Methods. cTnI and creatine kinase-MB fraction (CK-MB) mass concentration were collected serially during the first 48 h from onset of symptoms in 1,047 patients  30 years old admitted for acute chest pain. Sensitivity, specificity and receiver operating characteristic curves were calculated for cTnI and CK-MB collected in the first 24 h.
Results. The sensitivity, specificity and positive predictive value of cTnI for major cardiac events were 47%, 80% and 19%, respectively. Among patients were who ruled out for myocardial infarction, cTnI was elevated in 26% who had major cardiac complications compared with 5% for CK-MB; the positive predictive value for an abnormal cTnI result was 8%. Elevated cTnI in the presence of ischemia on the electrocardiogram was associated with an adjusted odds ratio of 1.8 (95% confidence interval 1.1 to 2.9) for major cardiac events within 72 h. Among patients without a myocardial infarction or unstable angina, cTnI was not an independent correlate of complications.
Conclusions. In patients presenting to the ED with acute chest pain, cTnI was an independent predictor of major cardiac events. However, the positive predictive value of an abnormal assay result was not high in this heterogeneous cohort.
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Abbreviations and Acronyms
| | CK | = creatine kinase | | CK-MB | = creatine kinase-MB fraction | | cTnI | = cardiac troponin I | | ECG | = electrocardiogram, electrocardiographic | | ED | = emergency department | | NPV | = negative predictive value | | PPV | = positive predictive value | | PTCA | = percutaneous transluminal coronary angioplasty | | ROC | = receiver operating characteristic |
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