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Clinical significance of initial troponin I in the grey zone in emergency department chest pain patients: a retrospective pilot study
  1. Hwee Min Lee1,
  2. Debra Kerr2,
  3. Darach O'H Ici3,
  4. Anne-Maree Kelly4
  1. 1Department of Emergency Medicine, Western Health, Footscray, Australia
  2. 2School of Nursing and Midwifery, Victoria University, St Albans, Australia
  3. 3Centre for Cardiovascular Therapeutics, Western Health, Footscray, Australia
  4. 4Joseph Epstein Centre for Emergency Medicine Research at Western Health, St Albans, Australia
  1. Correspondence to Professor Anne-Maree Kelly, JECEMR, Sunshine Hospital, Furlong Road, St Albans 3021; anne-maree.kelly{at}


Aim ‘Normal’ range for cardiac troponin I (TnI) has changed with more sensitive tests, but the validity of low-level elevations is contentious. We aimed to describe the characteristics and outcome of patients with an initial TnI level 1–5 times the upper limit of normal.

Methods Retrospective study of patients assessed for ACS with initial TnI level between 0.05–0.19 ng/ml. Data collected included demographics, clinical data, TnI levels and outcome. Primary outcome was the proportion of patients who had a serial TnI rise consistent with ACS.

Results 72 patients were studied; median age 71, median TIMI score 3, 66.7% male. 35 patients (48.6%) had a TnI rise consistent with ACS.

Conclusion Approximately half of patients with initial TnI between 0.05–0.19ng/ml had a TnI rise consistent with ACS. An initial TnI in this range is not, of itself, indicative of ACS. Clinical decision-making should be guided by clinical features and serial TnI measurement.

  • Acute coronary syndrome
  • cardiac care
  • chest pain
  • diagnosis
  • troponin

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  • Funding Funding was from departmental funds only.

  • Competing interests None.

  • Ethics approval The study was approved by Western Health under the NHMRC quality assurance project guideline.

  • Provenance and peer review Not commissioned; externally peer reviewed.