Skip to main content

Advertisement

SpringerLink
Log in

Associations between elevated high-sensitive cardiac troponin t and outcomes in patients with acute abdominal pain

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to determine outcomes in patients presenting to emergency department (ED) with acute abdominal pain and suspected occult myocardial injury [OMI (high-sensitive cardiac troponin T, hs-cTnT level > 14 ng/L)] without clinical signs of myocardial ischaemia. We hypothesized that OMI is a common entity associated with poor outcomes.

Methods

After institutional research ethics committee approval, a retrospective review was performed on patients subjected to extended use of hs-cTnT measurements during two months period in patients admitted to ED with a chief complaint of abdominal pain, aged 30 years or older and triaged to red, orange, or yellow categories. Primary outcomes were 30-day, six-month, and one-year mortality, respectively. Adjusted mortality rates were compared using the Cox proportional hazard regression model.

Results

Overall, 1000 consecutive patients were screened. A total of 375 patients were subjected to hs-cTnT measurement and 156 of them (41.6%) experienced OMI. None of the patients had acute myocardial infarction diagnosed in the ED. Patients with OMI had a significantly higher 30-day, six-month and one-year mortality compared to the normal hs-cTnT level group [12.8% (20/156) vs. 3.7% (8/219), p = 0.001, 34.0% (53/156) vs. 6.9% (15/219), p < 0.001 and 39.1% (61/156) vs. 9.1 (20/219), p < 0.001, respectively]. OMI was an independent risk factor for mortality at every time point analyzed.

Conclusion

Our investigation noted OMI in older patients with co-morbidities and in higher triage category presenting with abdominal pain to ED, respectively. OMI is an independent risk factor for poor outcomes that warrants appropriate screening and management strategy. Our results support the use of hs-cTnT as a prognostication tool in this subgroup of ED patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bhuiya FA, McCaig LF. Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief. 2010;43:1–8.

    Google Scholar 

  2. Moore BJ (IBM Watson Health), Stocks C (AHRQ), Owens PL (AHRQ). Trends in Emergency Department Visits, 2006–2014. HCUP Statistical Brief #227. September 2017. Agency for Healthcare Research and Quality, Rockville MD.

  3. Health & welfare overview [Internet]. Australian Institute of Health and Welfare. [cited 2020 Sep 5]. https://www.aihw.gov.au/reports-data/health-welfare-overview

  4. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. J Am Coll Cardiol. 2018. https://doi.org/10.1016/j.jacc.2018.08.1038.

    Article  PubMed  Google Scholar 

  5. Lindner G, Pfortmueller CA, Braun CT, Exadaktylos AK. Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room: a cross-sectional analysis. Internal Emerg Med. 2014. https://doi.org/10.1007/s11739-013-1030-y.

    Article  Google Scholar 

  6. Latini R, Masson S, Anand IS, Missov E, Carlson M, Vago T, et al. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation. 2007. https://doi.org/10.1161/CIRCULATIONAHA.106.655076.

    Article  PubMed  Google Scholar 

  7. Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, et al. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med. 2009. https://doi.org/10.1056/NEJMoa0805299.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wilhelm J, Hettwer S, Schuermann M, Bagger S, Gerhardt F, Mundt S, et al. Elevated troponin in septic patients in the emergency department: frequency, causes, and prognostic implications. Clin Res Cardiol. 2014. https://doi.org/10.1007/s00392-014-0684-4.

    Article  PubMed  Google Scholar 

  9. Keskpaik T, Starkopf J, Kirsimägi Ü, Mihnovitš V, Lomp A, Raamat E-M, et al. The role of elevated high-sensitivity cardiac troponin on outcomes following severe blunt chest trauma. Injury. 2020. https://doi.org/10.1016/j.injury.2019.12.037.

    Article  PubMed  Google Scholar 

  10. Writing Committee for the VISION Study Investigators, Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, et al. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017. https://doi.org/10.1001/jama.2017.4360.

    Article  Google Scholar 

  11. Baron JM, Lewandrowski EL, Januzzi JL, Bajwa EK, Thompson BT, Lewandrowski KB. Measurement of high-sensitivity troponin T in noncardiac medical intensive care unit patients. Am J Clin Pathol. 2014. https://doi.org/10.1309/AJCPLVQQY35XTFVN.

    Article  PubMed  Google Scholar 

  12. DeFilippis AP, Chapman AR, Mills NL, de Lemos JA, Arbab-Zadeh A, Newby LK, et al. Assessment and treatment of patients with type 2 myocardial infarction and acute nonischemic myocardial injury. Circulation. 2019. https://doi.org/10.1161/CIRCULATIONAHA.119.040631.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kadesjö E, Roos A, Siddiqui A, Desta L, Lundbäck M, Holzmann MJ. Acute versus chronic myocardial injury and long-term outcomes. Heart. 2019. https://doi.org/10.1136/heartjnl-2019-315036.

    Article  PubMed  Google Scholar 

  14. Widgren BR, Jourak M. Medical emergency triage and treatment system (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med. 2011. https://doi.org/10.1016/j.jemermed.

    Article  PubMed  Google Scholar 

  15. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016. https://doi.org/10.1001/jama.2016.0287.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Song J-U, Sin CK, Park HK, Shim SR, Lee J. Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis. Crit Care. 2018. https://doi.org/10.1186/s13054-018-1952-x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Müokardiinfarktiregister. [cited 2020 Aug 5]. https://www.kliinikum.ee/leht/e-keskkond/377-mueokardiinfarktiregister

  18. Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest. 2004. https://doi.org/10.1378/chest.126.2.461.

    Article  PubMed  Google Scholar 

  19. Nakahashi T, Sakata K, Masuda J, Kumagai N, Higuma T, Ogimoto A, et al. Comparison of door-to-balloon time and 30-day mortality according to symptom presentation in patients with acute myocardial infarction. Circ Rep. 2021. https://doi.org/10.1253/circrep.CR-21-0006.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Botto F, Alonso-Coello P, Chan MTV, Villar JC, Xavier D, Srinathan S, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014. https://doi.org/10.1097/ALN.0000000000000113.

    Article  PubMed  Google Scholar 

  21. Shen J-T, Xu M, Wu Y, Wen S-H, Li X, Zhao B-C, et al. Association of pre-operative troponin levels with major adverse cardiac events and mortality after noncardiac surgery: a systematic review and meta-analysis. Eur J Anaesthesiol. 2018. https://doi.org/10.1097/EJA.0000000000000868.

    Article  PubMed  Google Scholar 

  22. Haaf P, Drexler B, Reichlin T, Twerenbold R, Reiter M, Meissner J, et al. High-sensitivity cardiac troponin in the distinction of acute myocardial infarction from acute cardiac noncoronary artery disease. Circulation. 2012. https://doi.org/10.1161/CIRCULATIONAHA.112.100867.

    Article  PubMed  Google Scholar 

  23. Jarolim P. High sensitivity cardiac troponin assays in the clinical laboratories. Clin Chem Lab Med. 2015. https://doi.org/10.1515/cclm-2014-0565.

    Article  PubMed  Google Scholar 

  24. de Lemos JA, Drazner MH, Omland T, Ayers CR, Khera A, Rohatgi A, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010. https://doi.org/10.1001/jama.2010.1768.

    Article  PubMed  PubMed Central  Google Scholar 

  25. deFilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010. https://doi.org/10.1001/jama.2010.1708.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Courtney D, Conway R, Kavanagh J, O’Riordan D, Silke B. High-sensitivity troponin as an outcome predictor in acute medical admissions. Postgr Med J. 2014. https://doi.org/10.1136/postgradmedj-2013-132325.

    Article  Google Scholar 

  27. Devereaux PJ, Beattie WS, Choi PT-L, Badner NH, Guyatt GH, Villar JC, et al. How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005. https://doi.org/10.1136/bmj.38503.623646.8F.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Foucrier A, Rodseth R, Aissaoui M, Ibanes C, Goarin J-P, Landais P, et al. The long-term impact of early cardiovascular therapy intensification for postoperative troponin elevation after major vascular surgery. Anesth Analg. 2014. https://doi.org/10.1213/ANE.0000000000000302.

    Article  PubMed  Google Scholar 

  29. POISE Study Group, Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. The Lancet. 2008. https://doi.org/10.1016/S0140-6736(08)60601-7.

    Article  Google Scholar 

Download references

Funding

Toomas Marandi has been supported by Estonian Research Council [PRG435].

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia

    Triinu Keskpaik, Vladislav Mihnovitš, Anni Ruul & Joel Starkopf

  2. Department of Anesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia

    Triinu Keskpaik & Joel Starkopf

  3. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia

    Peep Talving

  4. Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia

    Peep Talving

  5. Department of Surgery, Tartu University Hospital, Tartu, Estonia

    Ülle Kirsimägi

  6. Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia

    Toomas Marandi

  7. Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia

    Toomas Marandi

  8. Quality Department, North Estonia Medical Centre, Tallinn, Estonia

    Toomas Marandi

Authors
  1. Triinu Keskpaik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peep Talving
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ülle Kirsimägi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vladislav Mihnovitš
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anni Ruul
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toomas Marandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joel Starkopf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Triinu Keskpaik.

Ethics declarations

Conflict of interest

None to declare.

Prior presentations

This work has not been formally presented.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 27 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keskpaik, T., Talving, P., Kirsimägi, Ü. et al. Associations between elevated high-sensitive cardiac troponin t and outcomes in patients with acute abdominal pain. Eur J Trauma Emerg Surg 49, 281–288 (2023). https://doi.org/10.1007/s00068-022-02057-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-022-02057-z

Keywords

Search

Navigation