J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 7, Number 6, June 2015, pages 464-471

Chief Complaint at Admission Relates to Troponin Level and Mortality in Patients With Non-ACS Troponin Elevation

Figure 1. Distribution of the peak TnT level among four time categories after admission in relation to the different chief complaints.

Figure 2. Cumulative proportion surviving among non-ACS troponin elevation in relation to chief complaint at admission.

**Table 1.** Baseline Characteristics
	ACS (n = 50)	Non-ACS TnT-el (n = 71)	Non-sign TnT-el (n = 33)	TnT-el of indet orig (n = 8)	No TnT-el (n = 325)
Values are mean ± SD, median (IQR) or number (%). El: elevation; sign: significant; indet: indeterminate; orig: origin; CHF: congestive heart failure; CAD: former percutaneous coronary intervention and/or coronary artery bypass grafting and/or acute myocardial infarction; BMI: body mass index; AF: atrial fibrillation/flutter; PM: pacemaker; HF: heart frequency; SBP: systolic blood pressure; DBT: diastolic blood pressure; eGFR: estimated glomerular filtration rate according to MDRD; Hb: hemoglobin; CRP: C-reactive protein; CCU: coronary care unit. P < 0.05 vs. non-ACS TnT-el. *P < 0.001 vs. non-ACS TnT-el.
Age (years)	74 ± 14	77 ± 12	70 ± 15	76 ± 13	64 ± 14
Female	21 (42)	28 (39)	12 (36)	6 (75)	165 (51)
Current smoker	8 (16)	10 (14)	4 (12)	1 (13)	58 (18)
Previous	13 (26)	25 (35)	17 (52)	3 (38)	94 (29)
CHF	14 (28)*	36 (51)	8 (24)	0	25 (8)
CAD	25 (50)	35 (49)	15 (45)	2 (25)	90 (28)
Hypertension	24 (48)	44 (62)	21 (64)	4 (50)	157 (48)
Diabetes	13 (26)	25 (35)	7 (21)	3 (38)	39 (12)
BMI (kg/m²)	26.3 ± 5.6	24.9 ± 4.7	25.8 ± 4.9	25 ± 2.9	27.1 ± 5.0
AF on arrival	6 (12)*	23 (32)	10 (30)	1 (13)	34 (10)
HF (beats/min)	91 ± 26	96 ± 30	82 ± 30	88 ± 28	78 ± 19
SBP (mm Hg)	152 ± 30	141 ± 33	148 ± 33	155 ± 18	154 ± 29
DBP (mm Hg)	86 ± 19*	77 ±18	80 ± 16	86 ± 13	83 ± 15
eGFR (mL/min/1.73²)	61 ± 30*	49 ± 26	56 ± 24	57 ± 24	77 ± 20
Hb (g/L)	131±29	126 ± 21	132 ± 16	136 ± 20	139 ± 15
CRP (mg/L)	6 (2 - 36)	14 (4 - 42)	7 (3 - 19)	6 (2 - 8)	2 (0 - 4)
Glucose (mmol/L)	7.5 (6.1 - 11.2)	7 (5.7 - 9.2)	6.9 (6.1 - 8.1)	9.4 (6.9 - 15.1)	6.1 (5.4 - 7.1)
Transferral CCU	29 (58)**	16 (23)	5 (15)	5 (63)	27 (8)
Hospitalization (days)	4 (3 - 7)**	2.5 (1 - 4.5)	2 (1 - 4)	4 (2 - 10)	1 (0.5 - 1)

Table 1. Baseline Characteristics

ACS (n = 50)

Non-ACS TnT-el (n = 71)

Non-sign TnT-el (n = 33)

TnT-el of indet orig (n = 8)

No TnT-el (n = 325)

Values are mean ± SD, median (IQR) or number (%). El: elevation; sign: significant; indet: indeterminate; orig: origin; CHF: congestive heart failure; CAD: former percutaneous coronary intervention and/or coronary artery bypass grafting and/or acute myocardial infarction; BMI: body mass index; AF: atrial fibrillation/flutter; PM: pacemaker; HF: heart frequency; SBP: systolic blood pressure; DBT: diastolic blood pressure; eGFR: estimated glomerular filtration rate according to MDRD; Hb: hemoglobin; CRP: C-reactive protein; CCU: coronary care unit. *P < 0.05 vs. non-ACS TnT-el. **P < 0.001 vs. non-ACS TnT-el.

Age (years)

74 ± 14

77 ± 12

70 ± 15

76 ± 13

64 ± 14

Female

21 (42)

28 (39)

12 (36)

6 (75)

165 (51)

Current smoker

8 (16)

10 (14)

4 (12)

1 (13)

58 (18)

13 (26)

25 (35)

17 (52)

3 (38)

94 (29)

CHF

14 (28)*

36 (51)

8 (24)

25 (8)

CAD

25 (50)

35 (49)

15 (45)

2 (25)

90 (28)

Hypertension

24 (48)

44 (62)

21 (64)

4 (50)

157 (48)

Diabetes

13 (26)

25 (35)

7 (21)

3 (38)

39 (12)

BMI (kg/m²)

26.3 ± 5.6

24.9 ± 4.7

25.8 ± 4.9

25 ± 2.9

27.1 ± 5.0

AF on arrival

6 (12)*

23 (32)

10 (30)

1 (13)

34 (10)

HF (beats/min)

91 ± 26

96 ± 30

82 ± 30

88 ± 28

78 ± 19

SBP (mm Hg)

152 ± 30

141 ± 33

148 ± 33

155 ± 18

154 ± 29

DBP (mm Hg)

86 ± 19*

77 ±18

80 ± 16

86 ± 13

83 ± 15

eGFR (mL/min/1.73²)

61 ± 30*

49 ± 26

56 ± 24

57 ± 24

77 ± 20

Hb (g/L)

131±29

126 ± 21

132 ± 16

136 ± 20

139 ± 15

CRP (mg/L)

6 (2 - 36)

14 (4 - 42)

7 (3 - 19)

6 (2 - 8)

2 (0 - 4)

Glucose (mmol/L)

7.5 (6.1 - 11.2)

7 (5.7 - 9.2)

6.9 (6.1 - 8.1)

9.4 (6.9 - 15.1)

6.1 (5.4 - 7.1)

Transferral CCU

29 (58)**

16 (23)

5 (15)

5 (63)

27 (8)

Hospitalization (days)

4 (3 - 7)**

2.5 (1 - 4.5)

2 (1 - 4)

4 (2 - 10)

1 (0.5 - 1)

**Table 2.** Chief Complaints at Admission
Chief complaints	ACS (n = 50)	Non-ACS TnT-el (n = 71)	Non-sign TnT-el (n = 33)	TnT-el of indet orig (n = 8)	No TnT-el (n = 325)
Values are number (%). One patient with a procedure related acute myocardial infarction is not presented in the table. El: elevation; sign: significant; indet: indeterminate; orig: origin. *P < 0.001 vs. non-ACS TnT-el.
Chest pain	37 (74)*	26 (37)	24 (73)	6 (75)	268 (82)
Dyspnoea	8 (16)*	18 (25)	4 (12)	1 (13)	9 (3)
Syncope/arrhythmia	3 (6)*	10 (14)	4 (12)	0	42 (13)
Others	2 (4)*	17 (24)	1 (3)	1 (13)	6 (2)

Table 2. Chief Complaints at Admission

Chief complaints

ACS (n = 50)

Non-ACS TnT-el (n = 71)

Non-sign TnT-el (n = 33)

TnT-el of indet orig (n = 8)

No TnT-el (n = 325)

Values are number (%). One patient with a procedure related acute myocardial infarction is not presented in the table. El: elevation; sign: significant; indet: indeterminate; orig: origin. *P < 0.001 vs. non-ACS TnT-el.

Chest pain

37 (74)*

26 (37)

24 (73)

6 (75)

268 (82)

Dyspnoea

8 (16)*

18 (25)

4 (12)

1 (13)

9 (3)

Syncope/arrhythmia

3 (6)*

10 (14)

4 (12)

42 (13)

Others

2 (4)*

17 (24)

1 (3)

1 (13)

6 (2)

**Table 3.** TnT Kinetics in Patients With ACS, Non-ACS TnT Elevation and Different Chief Complaints in Patients With Non-ACS TnT Elevation
Troponin categories	ACS (n = 50)	Non-ACS TnT-el (n = 71)	P-value	Non-ACS TnT-el (n = 71)
Values are median (IQR) (number of measurements) or number (%). P-value denotes comparison between ACS and non-ACS TnT-el with Mann-Whitney U-test or between all groups with Kruskall-Wallis ANOVA or maximum likelihood Chi-square.
TnT < 3 h (μg/L)	0.05 (0.01 - 0.14) (44)	0.05 (0.03 - 0.08) (66)		0.04 (0.03 - 0.06) (25)	0.06 (0.04 - 0.08) (17)	0.04 (0.02 - 0.05) (9)	0.06 (0.03 - 0.15) (15)	0.18
TnT 3 - 9 h (μg/L)	0.23 (0.10 - 0.51) (37)	0.05 (0.04 - 0.11) (60)		0.04 (0.02 - 0.08) (23)	0.07 (0.05 - 0.1) (13)	0.05 (0.04 - 0.14) (10)	0.07 (0.04 - 0.14) (14)	0.19
TnT 9 - 15 h (μg/L)	0.26 (0.1 - 0.97) (22)	0.06 (0.04 - 0.13) (50)		0.04 (0.03 - 0.1) (21)	0.08 (0.06 - 0.13) (15)	0.06 (0.04 - 0.13) (9)	0.07 (0.06 - 0.15) (5)	0.16
TnT > 15 h (μg/L)	0.55 (0.20 - 1.32) (24)	0.10 (0.04 - 0.3) (15)		0.03 (0.03 - 0.03) (2)	0.10 (0.05 - 0.37) (7)	0.03 (0.03 - 0.03) (1)	0.23 (0.10 - 0.3) (5)	0.07
Max TnT (μg/L)	0.31 (0.12 - 0.83) (50)	0.06 (0.04 - 0.12) (71)	< 0.001	0.04 (0.03 - 0.07) (26)	0.08 (0.06 - 0.12) (18)	0.06 (0.04 - 0.14) (10)	0.08 (0.04 - 0.16) (17)	0.04
Time to max TnT (h:min)	8:19 (3:01 - 18:21)	6:02 (0:31 - 11:02)	< 0.001	6:10 (0:55 - 10:17)	2:29 (0:24 - 13:14)	6:57 (3:56 - 11:02)	0:57 (0:19 - 8:59)	0.72
No. of max < 3 h	12 (24)	32 (45)		11 (42)	10 (56)	2 (20)	9 (53)
No. of max 3 - 9 h	13 (26)	16 (23)		6 (23)	1 (6)	5 (50)	4 (24)
No. of max 9 - 15 h	7 (14)	17 (24)		9 (34)	3 (17)	3 (30)	2 (12)
No. of max > 15 h	18 (36)	6 (9)	< 0.001	0	4 (22)	0	2 (12)	0.02

Table 3. TnT Kinetics in Patients With ACS, Non-ACS TnT Elevation and Different Chief Complaints in Patients With Non-ACS TnT Elevation

Troponin categories

ACS (n = 50)

Non-ACS TnT-el (n = 71)

P-value

Non-ACS TnT-el (n = 71)

Chest pain (n = 26)

Dyspnea (n = 18)

Syncope/arrhythmia (n = 10)

Others (n = 17)

P-value

Values are median (IQR) (number of measurements) or number (%). P-value denotes comparison between ACS and non-ACS TnT-el with Mann-Whitney U-test or between all groups with Kruskall-Wallis ANOVA or maximum likelihood Chi-square.

TnT < 3 h (μg/L)

0.05 (0.01 - 0.14) (44)

0.05 (0.03 - 0.08) (66)

0.04 (0.03 - 0.06) (25)

0.06 (0.04 - 0.08) (17)

0.04 (0.02 - 0.05) (9)

0.06 (0.03 - 0.15) (15)

0.18

TnT 3 - 9 h (μg/L)

0.23 (0.10 - 0.51) (37)

0.05 (0.04 - 0.11) (60)

0.04 (0.02 - 0.08) (23)

0.07 (0.05 - 0.1) (13)

0.05 (0.04 - 0.14) (10)

0.07 (0.04 - 0.14) (14)

0.19

TnT 9 - 15 h (μg/L)

0.26 (0.1 - 0.97) (22)

0.06 (0.04 - 0.13) (50)

0.04 (0.03 - 0.1) (21)

0.08 (0.06 - 0.13) (15)

0.06 (0.04 - 0.13) (9)

0.07 (0.06 - 0.15) (5)

0.16

TnT > 15 h (μg/L)

0.55 (0.20 - 1.32) (24)

0.10 (0.04 - 0.3) (15)

0.03 (0.03 - 0.03) (2)

0.10 (0.05 - 0.37) (7)

0.03 (0.03 - 0.03) (1)

0.23 (0.10 - 0.3) (5)

0.07

Max TnT (μg/L)

0.31 (0.12 - 0.83) (50)

0.06 (0.04 - 0.12) (71)

< 0.001

0.04 (0.03 - 0.07) (26)

0.08 (0.06 - 0.12) (18)

0.06 (0.04 - 0.14) (10)

0.08 (0.04 - 0.16) (17)

0.04

Time to max TnT (h:min)

8:19 (3:01 - 18:21)

6:02 (0:31 - 11:02)

< 0.001

6:10 (0:55 - 10:17)

2:29 (0:24 - 13:14)

6:57 (3:56 - 11:02)

0:57 (0:19 - 8:59)

0.72

No. of max < 3 h

12 (24)

32 (45)

11 (42)

10 (56)

2 (20)

9 (53)

No. of max 3 - 9 h

13 (26)

16 (23)

6 (23)

1 (6)

5 (50)

4 (24)

No. of max 9 - 15 h

7 (14)

17 (24)

9 (34)

3 (17)

3 (30)

2 (12)

No. of max > 15 h

18 (36)

6 (9)

< 0.001

4 (22)

2 (12)

0.02

**Table 4.** Univariate Predictors of 1-Year Mortality in Patients With ACS and Non-ACS TnT Elevation
	ACS (n = 50)	Non-ACS-TnT elevation (n = 71)
Hazard ratios (HR) apply for an SD increase in continuous variables and for yes compared to no for all categorical variables. *Non-significant, HR and CI.
Age (years)	2.68 (1.34 - 5.36)	0.005	1.66 (0.86 - 3.22)	0.13
Male gender	0.19 (0.04 - 0.90)	0.03	3.5 (0.77 - 16.0)	0.10
Diabetes	1.00(0.21 - 4.82)	0.99	0.67 (0.18 - 2.50)	0.56
Hypertension	0.36 (0.09 - 1.43)	0.15	0.32 (0.10 - 1.07)	0.06
Previous AMI	11.1 (1.4 - 89.3)	0.02	1.03 (0.33 - 3.21)	0.95
CHF	8.4 (2.08 - 34.2)	0.003	2.12 (0.64 - 7.05)	0.22
Current smoking	*	0.99	1.94 (0.53 - 7.19)	0.32
Ever smoking	0.25 (0.05 - 1.19)	0.08	0.66 (0.21 - 2.05)	0.47
eGFR	0.49 (0.29 - 0.82)	0.007	0.55 (0.31 - 0.96)	0.03
logCRP	2.5 (1.6 - 4.0)	< 0.001	2.2 (1.3 - 3.8)	0.004
Max TnT	1.29 (1.08 - 1.54)	0.005	0.51 (0.03 - 9.5)	0.66
Abs increase	1.24 (0.92 - 1.67)	0.15	0.08 (0.00 - 87)	0.49
Abs decrease	0.81 (0.64 - 1.04)	0.09	0.60 (0.08 - 4.6)	0.62
Chief complaint
Chest pain	2.7 (0.61 - 12.0)	0.18	0.19 (0.04 - 0.82)	0.03
Dyspnea	*	0.99	3.5 (1.4 - 8.7)	0.01
Arrhythmia	0.97(0.13 - 7.3)	0.97	0.3 (0.05 - 2.6)	0.29
Other	2.6 (0.3 - 19.7)	0.36	1.6 (0.6 - 4.4)	0.31
Cause
Renal failure			3.8 (1.1 - 13.0)	0.04
Structural heart disease			1.4 (0.6 - 3.6)	0.44
Arrhythmia			0.7 (0.2 - 2.5)	0.60
Respiratory disease			1.2 (0.4 - 3.6)	0.75
Infection			2.1 (0.8 - 6.0)	0.15

Table 4. Univariate Predictors of 1-Year Mortality in Patients With ACS and Non-ACS TnT Elevation

ACS (n = 50)

Non-ACS-TnT elevation (n = 71)

Hazard ratio (95% CI)

P-value

Hazard ratio (95% CI)

P-value

Hazard ratios (HR) apply for an SD increase in continuous variables and for yes compared to no for all categorical variables. *Non-significant, HR and CI.

Age (years)

2.68 (1.34 - 5.36)

0.005

1.66 (0.86 - 3.22)

0.13

Male gender

0.19 (0.04 - 0.90)

0.03

3.5 (0.77 - 16.0)

0.10

Diabetes

1.00(0.21 - 4.82)

0.99

0.67 (0.18 - 2.50)

0.56

Hypertension

0.36 (0.09 - 1.43)

0.15

0.32 (0.10 - 1.07)

0.06

Previous AMI

11.1 (1.4 - 89.3)

0.02

1.03 (0.33 - 3.21)

0.95

CHF

8.4 (2.08 - 34.2)

0.003

2.12 (0.64 - 7.05)

0.22

Current smoking

0.99

1.94 (0.53 - 7.19)

0.32

Ever smoking

0.25 (0.05 - 1.19)

0.08

0.66 (0.21 - 2.05)

0.47

eGFR

0.49 (0.29 - 0.82)

0.007

0.55 (0.31 - 0.96)

0.03

logCRP

2.5 (1.6 - 4.0)

< 0.001

2.2 (1.3 - 3.8)

0.004

Max TnT

1.29 (1.08 - 1.54)

0.005

0.51 (0.03 - 9.5)

0.66

Abs increase

1.24 (0.92 - 1.67)

0.15

0.08 (0.00 - 87)

0.49

Abs decrease

0.81 (0.64 - 1.04)

0.09

0.60 (0.08 - 4.6)

0.62

Chief complaint

Chest pain

2.7 (0.61 - 12.0)

0.18

0.19 (0.04 - 0.82)

0.03

Dyspnea

0.99

3.5 (1.4 - 8.7)

0.01

Arrhythmia

0.97(0.13 - 7.3)

0.97

0.3 (0.05 - 2.6)

0.29

Other

2.6 (0.3 - 19.7)

0.36

1.6 (0.6 - 4.4)

0.31

Cause

Renal failure

3.8 (1.1 - 13.0)

0.04

Structural heart disease

1.4 (0.6 - 3.6)

0.44

Arrhythmia

0.7 (0.2 - 2.5)

0.60

Respiratory disease

1.2 (0.4 - 3.6)

0.75

Infection

2.1 (0.8 - 6.0)

0.15