Ejection fraction and absolute delta troponin in the early emergency department assessment of high coronary disease burden in NSTEMI patients: a retrospective observational study

BACKGROUND: Patients with non-ST-segment elevation myocardial infarction (NSTEMI) are commonly evaluated first in the emergency department, where early estimation of coronary disease burden may support clinical risk assessment before invasive coronary angiography. This study investigated whether routinely available emergency department parameters, with particular emphasis on ejection fraction (EF) and absolute delta troponin, were associated with high angiographic coronary disease burden assessed by the Gensini score. METHODS: This retrospective observational study included adult NSTEMI patients admitted to the emergency department of a tertiary care hospital between January 1, 2024, and May 1, 2025, who subsequently underwent coronary angiography. Patients were divided into low and high Gensini groups using a predefined threshold of 40. Demographic characteristics, comorbidities, laboratory variables, echocardiographic findings, and absolute changes in serial troponin measurements were compared between groups. Independent associations with the high Gensini category were evaluated using multivariable binary logistic regression. Receiver operating characteristic curve analysis was used to assess the discriminatory performance of EF and absolute delta troponin/100. RESULTS: A total of 394 patients were included in the final analysis; 209 were classified into the low Gensini group and 185 into the high Gensini group. In the adjusted model, lower EF was independently associated with the high Gensini category (OR: 0.888; 95% CI: 0.859-0.918; p < 0.001), while higher absolute delta troponin/100 showed a positive independent association (OR: 1.161; 95% CI: 1.074-1.254; p < 0.001). Diabetes mellitus was also independently associated with the high Gensini category (OR: 1.851; 95% CI: 1.096-3.127; p = 0.021). EF and absolute delta troponin/100 both showed statistically significant discrimination for the high Gensini category, with AUC values of 0.783 and 0.758, respectively. CONCLUSIONS: In NSTEMI patients evaluated in the emergency department, lower EF and higher absolute delta troponin were independently associated with high angiographic coronary disease burden. EF showed slightly higher discriminatory performance than absolute delta troponin/100. These findings suggest that EF and absolute troponin change may provide complementary information during early emergency department assessment before coronary angiography, although they should not be interpreted as validated predictors of clinical outcomes.