55Positive troponin values above the 99th percentile strongly predict adverse outcome in patients with acute chest pain in whom acute coronary syndrome was ruled out

Abstract

Background: Current data indicate, that high‐sensitive troponin levels above the 99th percentile in patients presenting with chest pain are indicative for future cardiovascular events, even when acute coronary syndrome (ACS) was ruled out. Methods: BACC is a prospective study comprising 1,661 consecutive patients presenting to the emergency department of a large tertiary care center with suspected ACS since 2013. Main outcome measures were death, non‐fatal AMI, or coronary revascularization. The stenoCardia study comprises a total of 1,787 patients with suspected acute myocardial infarction (AMI) were consecutively enrolled in this multicenter study. Main outcome measures were death, non‐fatal AMI, or coronary revascularization. Results: Within the BACC study, 279 patients with at least one positive troponin T (Roche Diagnostics, 99th percentile 14 ng/L) value were discharged as non‐ ACS. Out of these, 40 subjects (14.3%) suffered an endpoint during 12 months of follow‐up. Within the StenoCardia study 144 subjects had at least on positive troponin I value (Abbott Diagnostics, 99th percentile 26.2 ng/L), and were finally discharged as non‐ACS. Out of these, 18 subjects (12.5%) suffered an endpoint during 6 months of follow‐up. The vast majority of these non‐ACS‐patients were discharged without specific/ preventive therapy (anti‐platelet or anti‐lipid). Conclusions: Troponin levels above the 99th percentile, in patients presenting with chest pain in whom ACS was ruled out, seem to mirror subclinical myocardial ischemia. There seems an unmet need and huge potential to reduce mortality and morbidity in these patients. The results of these analyses paved the way for the large controlled clinical trial ?GRAYZONE?: 3,000 troponin positive patients presenting at emergency room with acute chest pain, in whom an ACS was ruled out, will be assigned randomly to Aspirin and/ or Atorvastatin versus placebo (2x2 factorial design).