Risk prediction in patients with chest pain:: early assessment by the combination of troponin I results and electrocardiographic findings

Objective To evaluate the prognostic value of point of care troponin I (Tril) results in combination with findings from the admission electrocardiogram (ECG) in patients with chest pain. Methods Rapid measurements of Tril were performed in 191 consecutive patients with chest pain and a nondiagnostic ECG for myocardial infarction. Results Within 6 h from admission, maximum Tnl elevations of > 0.07 mu g/l and mu 0.1 mu g/l were noted in 59 and 39% of all patients, respectively. Tnl elevations in the range of 0.07-0.09 mu g/l were found in many patients with diagnoses other than acute coronary syndrome. By 6-month follow-up, cardiac death had occurred in 71 and 11% of patients with maximum Tnl >= 0.07 mu g/l and >= 0.1 mu g/l, respectively and myocardial reinfarction was documented in 12 and 15%, respectively. ST-segment depression on the admission ECG was present in 16% of all patients and was the electrocardiographic abnormality with the highest risk (cardiac death 77%, myocardial reinfarction 15%). The combination of Trill >= 0.1 mu g/l and ST-segment depression or an abnormal admission ECG in general allowed the identification of patients at low, intermediate and high cardiac risk, 3 h after admission. Conclusion A threshold of Tril >= 0.1 mu g/l corresponding to the 10% coefficient of variation is prognostically most suitable for prediction of cardiac events in patients with chest pain. The combination of Tril results and findings from the admission ECG improves prognostic assessment and allows early and reliable risk stratification in this patient population. (c) 2005 Lippincott Williams & Wilkins.