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Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry

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Abstract

Objectives

The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated.

Background

Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS).

Methods

A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed.

Results

A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7 %) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0 %. In contrast, 605 patients (27.3 %) underwent a coronary angiography without revascularization and had an ACS in 79.8 %. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4 %), pericarditis/myocarditis (4.5 %), decompensated congestive heart failure (3.7 %), Takotsubo cardiomyopathy (2.7 %), hypertensive crisis (2.4 %), and pulmonary embolism (0.3 %). During the 3-month follow-up, patients without revascularization had a higher mortality (12.1 vs. 4.5 %, p < 0.0001) representing the major contributor to the higher rate of MACCE (15.1 vs. 8.1 %, p < 0.001). These data were confirmed in a subgroup analysis of ACS patients with or without revascularization.

Conclusions

Patients presenting to a CPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted.

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Acknowledgments

The management of the registry at the Foundation Institut für Herzinfarktforschung is financially supported by the German Cardiac Society.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany

    Alexander Illmann & Harald Mudra

  2. Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany

    Thomas Riemer & Jochen Senges

  3. West German Heart Center Essen, University Duisburg-Essen, Essen, Germany

    Raimund Erbel

  4. 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany

    Evangelos Giannitsis

  5. Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany

    Christian Hamm

  6. 1st Department of Medicine, Städtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany

    Michael Haude

  7. Institute for Pathophysiology, University Duisburg-Essen, Essen, Germany

    Gerd Heusch

  8. Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany

    Lars S. Maier

  9. 2nd Department of Medicine, Johannes Gutenberg-University Mainz, Mainz, Germany

    Thomas Münzel

  10. Clinic for Cardiology and Angiology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany

    Claus Schmitt

  11. 2nd Department of Medicine, Westpfalz-Klinikum, Kaiserslautern, Germany

    Burghard Schumacher

  12. CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany

    Thomas Voigtländer

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  1. Alexander Illmann
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  2. Thomas Riemer
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  3. Raimund Erbel
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  14. Harald Mudra
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Correspondence to Harald Mudra.

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For the ALKK-Study Group.

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Illmann, A., Riemer, T., Erbel, R. et al. Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry. Clin Res Cardiol 103, 29–40 (2014). https://doi.org/10.1007/s00392-013-0619-5

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  • DOI: https://doi.org/10.1007/s00392-013-0619-5

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