Role of first-drawn indeterminate troponin-I levels in the Emergency Department

For Emergency Department (ED) patients presenting with acute chest pain, troponin-I (TnI) is reported not just as negative or positive, but also within an "indeterminate range". We reviewed 150 patients with a first-drawn ED TnI level in the indeterminate range (0.08-0.79 ng/dL) and compared outcomes to 150 control patients with a negative TnI. An initial ED indeterminate TnI yielded a statistically significant association with a composite adverse outcome (44% vs. 24%; OR = 2.49; CI = 1.52-4.08). Indeterminate TnI also showed a significantly increased risk of both an acute myocardial infarction and of the need for an invasive cardiac procedure during the admission. Our study further supports the hypothesis that any detectable level of TnI increases risk of cardiovascular events during acute hospitalization.