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J Korean Soc Emerg Med > Volume 34(6); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(6): 586-598.
고감도 트로포닌 측정 수준이 향상되면 응급실에서 퇴원한 저위험 흉통환자의 주요 심혈관사건 발생빈도가 감소하는가?
류현진1 , 박하영1 , 황태식2 , 김한별1 , 이주홍1
1인제대학교 해운대백병원 응급의학과
2연세대학교 용인세브란스병원 응급의학과
Validation of high-sensitivity troponin I levels for major adverse cardiac events in low risk chest pain patients
Hyun Jin Ryu1 , Ha Young Park1 , Tae Sik Hwang2 , Han Byeol Kim1 , Ju Hong Lee1
1Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
2Department of Emergency Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
Correspondence  Ha Young Park ,Tel: 051-797-0131, Fax: 051-797-0034, Email: cprrosc@gmail.com,
Received: October 9, 2022; Revised: November 2, 2022   Accepted: November 3, 2022.  Published online: December 31, 2023.
This study examined whether the efficiency of the level of detection (LOD) and upper reference limit (URL) for high-sensitivity cardiac troponin I (hs-cTnI) is increased when major adverse cardiovascular events (MACEs) occur in patients with low-risk chest pain who visit the emergency department (ED) and how long they stay in the ED.
The URL for hs-cTnI used in the hospital improved from 0.04 ng/mL (LOD <0.0041 ng/mL) in 2018 to 19.8 pg/mL (LOD <2.3 pg/mL) in 2019. In these two years, the occurrence of MACEs, frequency of hs-cTnI follow-up in the ER, and the length of stay in the ER were compared. In addition, the three calculated risk assessment scores for the safety level of early discharge were compared.
In 2018, there were six MACEs out of 120 patients (5.0%), no cardiac deaths, one acute myocardial infarction (AMI), and five unplanned coronary revascularizations. In 2019, six MACEs out of 105 patients (5.7%) were all unplanned coronary revascularizations without any cardiac deaths or AMIs.
Although the level of hs-cTnI measurement was improved, there was no difference in the incidence of MACEs in patients with low-risk chest pain who were discharged from the ED, and the number of hs-cTnI follow-ups and time in the ED increased. Interestingly, there were only short-term MACEs and no medium-term MACEs. In addition, there was little to no coronary artery occlusion disease. The risk assessment score combined with hs-cTnI improved the predictive performance for MACEs.
Key words: Troponin I; Acute coronary syndrome; Chest pain
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