Diagnostic and prognostic implications of troponin elevation without chest pain in the emergency department

Objective. To analyze the prognostic implications of the absence of chest pain in emergency department patients with elevated troponin I levels. Methods. Observational retrospective study of patients for whom troponin I level was analyzed at least once between January 2012 and December 2013. Patient characteristics were recorded and survival was modeled. Results. A total of 3629 patients were distributed in 4 groups according to troponin I level and chest pain as follows: chest pain without troponin I elevation (n = 1379), no chest pain and no troponin I elevation (n = 1196), chest pain with troponin I elevation (n = 517), and troponin I elevation but no chest pain (n = 537). The patients with troponin I elevation but no chest pain were older and had more chronic conditions as well as more alternative diagnoses to consider other than acute coronary syndrome. Mortality was also higher at 12 months (log rank test < 0.001) in these patients. Multivariate analysis showed that absence of chest pain accompanying troponin I elevation was an independent predictor of mortality (hazard ratio, 5.130; 95% CI, 3.291-7.996; P<.001) vs patients with chest pain but no troponin I elevation. Conclusion. The absence of chest pain in the presence of troponin I elevation identifies a heterogeneous group of patients with a worse 12-month prognosis.