European Heart Journal: Acute Cardiovascular Care 2016, Vol. 5(7) 61–71 © The European Society of Cardiology 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872615590146 acc.sagepub.com EUROPEAN SOCIETY OF CARDIOLOGY ® Introduction Acute aortic syndromes (AASs) are a life-threatening car- diovascular emergency with a mortality rate of up to 1%/h; 1 hence, prompt diagnosis and initiation of appropriate man- agement are of paramount importance. However, AAS pres- entation often mimics acute coronary syndromes (ACSs), leading to a number of imaging and laboratory investiga- tions, including serum troponin evaluation, which might be Troponin T elevation in acute aortic syndromes: Frequency and impact on diagnostic delay and misdiagnosis Fabio Vagnarelli 1 , Anna Corsini 1 , Giulia Bugani 1 , Massimiliano Lorenzini 1 , Simone Longhi 1 , Maria Letizia Bacchi Reggiani 1 , Elena Biagini 1 , Maddalena Graziosi 1 , Laura Cinti 1 , Giulia Norscini 1 , Nevio Taglieri 1 , Franco Semprini 1 , Samuele Nanni 1 , Ferdinando Pasquale 1 , Guido Rocchi 1 , Giovanni Melandri 1 , Giuseppe Ambrosio 2 and Claudio Rapezzi 1 Abstract Aims: Despite troponin assay being a part of the diagnostic work up in many conditions with acute chest pain, little is known about its frequency and clinical implications in acute aortic syndromes (AASs). In our study we assessed frequency, impact on diagnostic delay, inappropriate treatments, and prognosis of troponin elevation in AAS. Methods and results: Data were collected from a prospective metropolitan AAS registry (398 patients diagnosed between 2000 and 2013). Cardiac troponin test, using either standard or high sensitivity assay, was performed according to standard protocol used in chest pain units. Troponin T values were available in 248 patients (60%) of the registry population; the overall frequency of troponin positivity was 28% (ranging from 16% to 54%, using standard or high sensitivity assay respectively, p = 0.001). Troponin positivity was frequently associated with acute coronary syndromes (ACS)-like electrocardiogram findings, and with a twofold increased risk of long in-hospital diagnostic time (odds ratio (OR) 1.92, 95% confidence interval (CI) 1.05–3.52, p = 0.03). The combination of positive troponin and ACS-like electrocardiogram abnormalities resulted in a significantly increased risk of in-hospital delay/coronary angiography/ antithrombotic therapy due to a misdiagnosis of ACS (OR 2.48, 95% CI 1.12–5.54, p = 0.02). However, troponin positivity was not associated with in-hospital mortality (OR 1.63, 95% CI 0.86–3.10, p = 0.131). Conclusions: Troponin positivity was a frequent finding in AAS patients, particularly when a high sensitivity assay was employed. Abnormal troponin values were strongly associated with ACS-like electrocardiogram findings and with in- hospital diagnostic delay but apparently they did not influence in-hospital mortality. Keywords Aortic dissection, troponin T, delay, outcome Date received: 8 February 2015; accepted: 15 May 2015 1 Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy 2 Department of Cardiology, University of Perugia School of Medicine, Italy Corresponding author: Claudio Rapezzi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy. Email: claudio.rapezzi@unibo.it 590146ACC 0 0 10.1177/2048872615590146European Heart Journal: Acute Cardiovascular CareVagnarelli et al. research-article 2015 Original scientific paper Downloaded from https://academic.oup.com/ehjacc/article/5/7/61/5922312 by guest on 30 January 2023