BACKGROUND There is a paucity of data on the association between high-sensitivity cardiac troponin (hs-cTn) levels and outcomes in patients with chest pain but no myocardial infarction (MI), or any other condition that may lead to acutely elevated troponin levels. OBJECTIVES The authors hypothesized that any detectable high-sensitivity cardiac troponin T (hs-cTnT) level is associated with adverse outcomes. METHODS All patients (N = 22,589) >25 years of age with chest pain and hs-cTnT analyzed concurrently in the emergency department of Karolinska University Hospital, Stockholm, Sweden from 2011 to 2014 were eligible for inclusion. After excluding all patients with acute conditions that may have affected hs-cTnT, or MI associated with the visit, or insufficient information to determine whether troponin levels were stable, Cox regression was used to estimate risks for all-cause, cardiovascular, and noncardiovascular mortality, MI, and heart failure at different levels of troponins. RESULTS A total of 19,460 patients with a mean age of 54 ± 17 years were included. During a mean follow-up of 3.3 ± 1.2 years, 1,349 (6.9%) patients died. Adjusted hazard ratios (with 95% confidence intervals) for all-cause mortality were 2.00 (1.66 to 2.42), 2.92 (2.38 to 3.59), 4.07 (3.28 to 5.05), 6.77 (5.22 to 8.78), and 9.68 (7.18 to 13.00) in patients with hs-cTnT levels of 5 to 9, 10 to 14, 15 to 29, 30 to 49, and ≥50 ng/l, respectively, compared with patients with hs-cTnT levels <5 ng/l. There was a strong and graded association between all detectable levels of hs-cTnT and risk for MI, heart failure, and cardiovascular and noncardiovascular mortality. CONCLUSIONS Among patients with chest pain and stable troponin levels, any detectable level of hs-cTnT is associated with an increased risk of death and cardiovascular outcomes and should merit further attention.

中文翻译：

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胸痛患者稳定的高敏心肌肌钙蛋白 T 水平和结果

背景 关于高敏心肌肌钙蛋白 (hs-cTn) 水平与胸痛但无心肌梗死 (MI) 或任何其他可能导致肌钙蛋白水平急剧升高的患者的结果之间的关联的数据很少。目标作者假设任何可检测的高敏心肌肌钙蛋白 T (hs-cTnT) 水平都与不良结局相关。方法 2011 年至 2014 年在瑞典斯德哥尔摩卡罗林斯卡大学医院急诊科同时分析的所有 25 岁以上胸痛和 hs-cTnT 患者（N = 22,589）均符合纳入标准。在排除所有可能影响 hs-cTnT 或与就诊相关的 MI 的急性疾病患者后，或没有足够的信息来确定肌钙蛋白水平是否稳定后，Cox 回归用于估计不同肌钙蛋白水平下的全因、心血管和非心血管死亡率、MI 和心力衰竭的风险。结果共纳入了 19,460 名平均年龄为 54 ± 17 岁的患者。在平均 3.3 ± 1.2 年的随访期间，1,349 (6.9%) 名患者死亡。全因死亡率的调整后风险比（95% 置信区间）为 2.00（1.66 至 2.42）、2.92（2.38 至 3.59）、4.07（3.28 至 5.05）、6.77（5.22 至 8.78）和 7.108（7.108） ) 与 hs-cTnT 水平 <5 ng/l 的患者相比，hs-cTnT 水平分别为 5 至 9、10 至 14、15 至 29、30 至 49 和 ≥ 50 ng/l 的患者。所有可检测到的 hs-cTnT 水平与 MI、心力衰竭以及心血管和非心血管死亡风险之间存在强烈的分级关联。