Kürşat Kaan KERİMOĞLU
Meandros Medical and Dental Journal - 2026;27(3):380-391
Objective: This study aimed to evaluate the short- and mid-term outcomes of patients discharged from the emergency department (ED) with elevated high-sensitivity cardiac troponin I (hs-cTnI) levels, in the absence of standardized management protocols. Materials and Methods: In this retrospective cohort study, outcomes were compared among adult patients discharged from the ED between January 2023 and December 2024. Patients with elevated hs-cTnI levels (>15 ng/L) were matched with controls possessing normal levels. The primary outcomes assessed included all-cause mortality at 30 and 90 days and healthcare revisits. Survival and prognostic analyses were conducted utilizing Kaplan-Meier and ROC methods. Results: Among 1,144 discharged patients, 568 had elevated hs-cTnI levels. The 90-day mortality rate was significantly higher in the case group than in the control group (7.0% vs 2.1%; OR = 3.56; p <0.001). Additionally, the rates of 30- and 90-day revisits were elevated in the group with increased hs-cTnI (16.0% and 21.7%, respectively). Kaplan-Meier analysis demonstrated significantly reduced 90-day survival among patients with elevated hs-cTnI levels (mean survival of 87.5 days versus 89.1 days; log-rank p <0.001). ROC analysis showed that a peak hs-cTnI level above approximately 20 ng/L was associated with 90-day mortality, but its discriminatory performance was limited (AUC: 0.626; 95% CI: 0.545-0.706). Conclusion: Patients discharged from the ED with elevated hs-cTnI levels exhibited increased mid-term mortality and revisit rates. Even mild elevations in hs-cTnI may serve as a supplementary marker of increased post-discharge risk, underscoring the importance of structured discharge procedures and follow-up protocols in this patient population.
