Table 4

Details of 15 Patients With Chest Pain and a First High-Sensitivity Cardiac Troponin T Level of <5 ng/l Combined With No Signs of Ischemia on an Electrocardiogram, Who Had a Final Diagnosis of Myocardial Infarction

SexAge, yrsPrevious Medical HistoryCurrent Medical HistoryTime from Onset of Symptoms to 1st, 2nd and 3rd hs-cTnT LevelECG Assessment by the ED PhysicianClinical Course
Male48This patient had COPD, never smoked, and had a BMI of 31 kg/m2.Sudden onset of chest pain and tachycardia in the morning.<1 h: <5 ng/l
6–7 h: 33 ng/l
12–13 h: 23 ng/l
SR, 108 beats/min, no signs of ischemia.Coronary angiography was performed on day 3, and a stent was placed in the LAD. The final diagnosis was NSTEMI.
Female52This patient had hypertension, was an ex-smoker, and had a BMI of 22 kg/m2.Sudden onset of chest discomfort in the morning.2–3 h: <5 ng/l
8–9 h: 18 ng/l
14–15 h: 9 ng/l
SR, 97 beats/min, nonspecific ST-segment changes in leads V4–V6.Coronary angiography on day 4 was normal. The final diagnosis was NSTEMI.
Male39This patient had hypertension, was an ex-smoker, and had a BMI of 28 kg/m2.Sudden onset of chest pain and nausea during physical activity.1–2 h: <5 ng/l
7–8 h: 1,930 ng/l
SR, 55 beats/min, ST-segment elevation in leads II and aVF.Primary PCI was performed, and a stent was placed in the RCA. The final diagnosis was STEMI.
Male64This patient was a previously healthy smoker and had a BMI of 28 kg/m2.Sudden left-sided stabbing sensation in the chest.<1 h: <5 ng/lSR, 85 beats/min, no signs of ischemia.This patient was discharged from the ED, but returned after 18 days with STEMI, which was treated with primary PCI with stenting of the LAD.
Male57This patient had a previous CABG, never smoked, and had a BMI of 25 kg/m2.Sudden onset of chest pain and nausea in the morning.1–2 h: <5 ng/l
7–8 h: 0.16 ng/l
13–14 h: 0.34 ng/l
SR, 63 beats/min, Q-wave in lead III.Coronary angiography was performed on day 3, and a stent was placed in the RCA. The final diagnosis was NSTEMI.
Male59This patient had hypertension, was a current smoker, and had a BMI of 27 kg/m2.Sudden onset of chest pain during the night.1–2 h: <5 ng/l
7–8 h: 81 ng/l
13–14 h: 149 ng/l
SR, ST-segment depression in leads I and aVL.Coronary angiography was performed on day 3, and a stent was placed in the RCA. The final diagnosis was NSTEMI.
Male62This patient was a nonsmoker and had a BMI of 28 kg/m2.Sudden onset of recurrent chest pain.1–2 h: <5 ng/l
7–8 h: 21 ng/l
13–14 h: 21 ng/l
SR, 107 beats/min, no signs of ischemia.Coronary angiography was performed on day 2, and a stent was placed in the LAD. The final diagnosis was NSTEMI.
Female72This patient was a current smoker and had a BMI of 22 kg/m2.Sudden onset of left-sided chest pain in the morning.<1 h: <5 ng/l
6–7 h: 4,560 ng/l
SR, 45 beats/min, no signs of ischemia.A second ECG performed 1 h after the first ECG showed ST-segment elevation in the inferior leads. Primary PCI was performed, and a stent was placed in the LCX. The final diagnosis was STEMI.
Male68This patient had hypertension, was a nonsmoker, and had a BMI of 31 kg/m2.Sudden onset of chest pain, diaphoresis, nausea, and dyspnea.2–3 h: <5 ng/l
8–9 h: 18 ng/l
14–15 h: 15 ng/l
SR, 110 beats/min, no signs of ischemia.Coronary angiography was performed on day 4, and was normal. The final diagnosis was NSTEMI.
Male64This patient was a current smoker and had a BMI of 31 kg/m2.Sudden onset of chest pain and diaphoresis at noon.1–2 h: <5 ng/l
7–8 h: 158 ng/l
13–14 h: 888 ng/l
SR, 60 beats/min, T-wave inversion in leads V1 and V2.A second ECG performed 30 min after the first ECG showed ST-segment elevation in the inferior leads. Primary PCI was performed, and a stent was placed in the RCA. The final diagnosis was STEMI.
Male56This patient was a current smoker and had a BMI of 20 kg/m2.Sudden onset of chest pain during physical activity.1–2 h: <5 ng/l
7–8 h: 29 ng/l
13–14 h: 56 ng/l
SR, no signs of ischemia.Coronary angiography was performed on day 5, and was normal. The final diagnosis was NSTEMI.
Female68This patient had 3 previous MIs and a previous CABG, was an active smoker, and had a BMI of 17 kg/m2.Sudden onset of left-sided chest pain during physical activity.>3 h: <5 ng/l
>9 h: 40 ng/l
SR, 60 beats/min, no signs of ischemia.Coronary angiography was performed on day 2 and showed no significant stenosis. The final diagnosis was NSTEMI.
Female56This patient was an active smoker and had a BMI of 27 kg/m2.Sudden onset of chest pain during the night.<1 h: <5 ng/l
6–7 h: 19 ng/l
SR, 76 beats/min, no signs of ischemia.ECG later on the day of admission showed ST-segment elevation. Coronary angiography showed no significant stenosis. The final diagnosis was STEMI.
Male54This patient had hypertension, was an ex-smoker, and had a BMI of 26 kg/m2.Sudden onset of chest pain in the morning.1–2 h: <5 ng/l
7–8 h: 157 ng/l
13–14 h: 92 ng/l
SR, nonsignificant ST-segment elevation in leads V3–V6.Coronary angiography was performed on day 3 and showed no significant stenosis. The final diagnosis was NSTEMI.
Male72This patient had a previous stroke, was a nonsmoker, and had a BMI of 24 kg/m2.Sudden onset of chest pain during the night.>3 h: <5 ng/l
>9 h: 12 ng/l
> 15 h: 29 ng/l
SR, no signs of ischemia.Coronary angiography was performed on day 3 and showed no significant stenosis. The final diagnosis was NSTEMI.

BMI = body mass index; BP = blood pressure; ECG = electrocardiogram; hs-cTnT = high-sensitivity cardiac troponin T; LAD = left anterior descending artery; LCX = left circumflex artery; MI = myocardial infarction; PCI = percutaneous coronary intervention; RR = respiratory rate; SR = sinus rhythm; STEMI = ST-segment elevation myocardial infarction.

  • This patient had cardiac troponin I analyzed after he was admitted to the cardiac care unit.