Kim DH, et al. - Considering the difficulties encountered in differentiating coronary or non-coronary causes in patients with elevated troponin I (TnI) in the emergency department (ED), researchers developed a clinical decision tool for differentiating a coronary cause in these patients. Findings suggest the utility of the ratio of N-terminal pro-Btype natriuretic peptide (NT-proBNP)/Tnl in distinguishing whether elevated TnI is caused by acute coronary syndromes (ACSs) or from conditions other than ACS.

Methods

• Researchers conducted a retrospective observational study enrolling consecutive ED patients.
• Patients were eligible for inclusion if they were ≥ 16?years of age, had admitted through ED with a medical illness, and TnI levels at initial evaluation in the ED were ≥ 0.2?ng/mL.
• They excluded patients diagnosed with ST elevation myocardial infarction or congestive heart failure.
• Analysis of coronary angiography, electrocardiogram, laboratory results, echocardiography, and clinical characteristics was performed.

Results

• Researchers included 1,441 patients.
• Categorization of 603 and 838 patients into an acute coronary syndrome (ACS) group and non-acute coronary syndrome (non-ACS) group, respectively, was performed.
• The non-ACS group displayed significantly higher ratio of N-terminal pro-Btype natriuretic peptide (NT-proBNP) to TnI vs the ACS group.
• In this study, the AUC of NT-proBNP/TnI was 0.805 (95% CI 0.784–0.826) and was superior to TnI, NT-proBNP, or the ratio of NT-proBNP to creatinine kinase-MB.
• The non-ACS group patients with high levels of TnI and BNP showed more critically ill manifestation at the time of presentation, and displayed higher mortality.