J Emerg Med. 2025 Sep 10;80:134-144. doi: 10.1016/j.jemermed.2025.09.011. Online ahead of print.

BACKGROUND: Cardiac troponin is routinely measured in the emergency department (ED) to evaluate patients with chest discomfort or dysrhythmias. However, its prognostic value in patients presenting with stable supraventricular tachycardia (SVT) remains uncertain.

OBJECTIVES: To assess the prognostic value of troponin for 30-day major adverse cardiac events (MACE) in adult patients presenting with stable SVT in the ED.

METHODS: This was a retrospective, multi-center cohort study conducted in EDs in North Texas. Adult patients presenting with stable SVT in the ED were included. The primary endpoint was the occurrence of 30-day MACE, defined as a composite outcome of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, and all-cause mortality.

RESULTS: A total of 493 patient encounters met inclusion criteria. Of these, 34 (6.9%) did not have troponin measured, 349 (70.8%) had non-elevated troponin levels, and 110 (22.3%) had elevated troponin levels. Patients who underwent troponin testing were at higher risk of MACE compared with those without testing (p < 0.001). Among patients with troponin testing, MACE occurred in 28.2% of those with elevated troponin versus 4.6% of those with non-elevated troponin (p < 0.001). Elevated troponin was associated with higher odds of 30-day MACE (OR 5.32, 95% CI: 1.92-14.7; p < 0.001). Compared to non-elevated troponin group, patients with elevated troponin had higher rates of ED SVT recurrence, hospital, and intensive care unit (ICU) admission.

CONCLUSION: Elevated troponin levels were associated with a significantly increased risk of 30-day MACE in our cohort. These findings highlight a potential role for troponin in identifying patients at higher risk for adverse short-term cardiac outcomes, even after successful rhythm conversion.

PubMed:41275846 | DOI:10.1016/j.jemermed.2025.09.011