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Licensed Unlicensed Requires Authentication Published by De Gruyter January 15, 2021

Prognostic implication of elevated cardiac troponin I in patients visiting emergency department without diagnosis of coronary artery disease

  • Minseok Song , Taerim Kim , Eun-Jin Kang , Jong Eun Park , Soo Hyun Park , Won Cul Cha , Hee Yoon , Sung Yeon Hwang , Tae Gun Shin , Min Seob Sim , IkJoon Jo , Hyung-Doo Park and Jin-Ho Choi EMAIL logo



Elevated cardiac troponin is not uncommon in patients visiting emergency department (ED) even without coronary artery disease, but its prognostic implication is not well understood in such patients.


In this retrospective single-center registry, we investigated clinical outcome of patients visiting ED without documented coronary artery disease. Patients were categorized according to the maximal value of Siemens ADVIA Centaur TnI-Ultra assay (TnI) within 24 h after visit. Primary endpoint was 180-day all-cause death that included cardiac and non-cardiac death.


A total of 35,205 patients with median age 61 years and male gender 54.7% were included. Below the lowest level of detection (LOD) (≤0.006 ng/mL), between LOD and assay-specific <99th percentile (0.007–0.039 ng/mL), below median of ≥99th percentile (0.040–0.149 ng/mL), and above median of ≥99th percentile (≥0.150 ng/mL) TnI were found in 18,502 (52.6%), 11,338 (32.2%), 3,029 (8.6%), and 2,336 (6.6%) patients. In the 180-day follow-up period, 4,341 (12.3%) all-cause death including 694 (2.0%) cardiovascular death and 3,647 (10.4%) non-cardiovascular death developed. The risks of all-cause, cardiovascular, and non-cardiovascular death increased across higher TnI strata (hazard ratio [HR]=1.3 to 2.4; 2.0 to 9.3; 1.3 to 1.7; p<0.001, all). Analyses of multivariate models showed consistent results.


In patients visiting ED, elevated TnI was associated with higher risk of 180-day cardiovascular and non-cardiovascular death. Patients with elevated TnI may need additional evaluation or careful follow-up even without primary diagnosis of coronary artery disease.

Corresponding author: Jin-Ho Choi, MD, PhD, Professor, Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro, Gangnam-ku, 06355, Seoul, Republic of Korea, Phone: +82 2 3410 3419, E-mail:
Minseok Song and Taerim Kim contributed equally as first authors.

Funding source: Ministry of Trade Industry & Energy, Ministry of Science & ICT, Ministry of Health and Welfare under Technology Development Program for Ai-Bio-Robot-Medicine Convergence

Award Identifier / Grant number: 20001704

Funding source: National Research Foundation of Korea

Award Identifier / Grant number: 2017R1A2B310918

  1. Research funding: This study was supported by National Research Foundation of Korea (#2017R1A2B310918) and Ministry of Trade Industry & Energy, Ministry of Science & ICT, Ministry of Health and Welfare under Technology Development Program for Ai-Bio-Robot-Medicine Convergence (20001704).

  2. Author contributions: All authors had access to the data and a role in writing the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was waived given the retrospective design, the use of anonymized big database, and the reporting of aggregated results.

  5. Ethical approval: The Samsung Medical Center Institutional Review Board approved this study.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-09-18
Accepted: 2020-12-22
Published Online: 2021-01-15
Published in Print: 2021-05-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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