Clinical indications for requesting high-sensitivity troponin I in the emergency department

Abstract

Objectives: The aim of this study is to evaluate the presenting symptoms, risk factors and cardiac origin of high-sensitivity troponin I (Hs-TnI), the tendency of emergency physicians to use Hs-TnI in a general emergency room (ER) and the validity of requesting an Hs-TnI routinely. Methodology: A retrospective cohort study with 904 patients presenting at a tertiary hospital ER with an Hs-TnI requested. The study was conducted for 15 months. Results: Of the sample, 20.4% (n = 184) presented with dyspnea, 18.03% (n = 163) with chest pain and a small proportion (12.94%, n = 117) with epigastric abdominal pain. Patients presenting with chest pain and a history of dyslipidemia were at a higher risk of developing acute coronary syndrome compared to the group without dyslipidemia (relative risk [RR] = 1.62 [1.01–2.58] P = 0.044). Diabetes and hypertension were the most prevalent chronic comorbidities in patients with dyspnea with a risk of (RR = 5.19 (0.68–39.27) P < 0.068). Patients who presented with epigastric pain and had a history of dyslipidemia had a risk of (RR = 5.23 (1.33–20.54) P = 0.009). Conclusion: The presenting symptoms should be taken into consideration by the emergency department physician to support the request for an Hs-TnI laboratory test. The yield and risk were both low in random screening.

Keywords

• chest pain
• myocardial infarction
• myocardial ischemia
• troponin i