53 y/o M PMD ESRD on dialysis presents with mild chest pain, now resolved. His EKG is unremarkable and trop is mildly elevated. There are no signs of overt heart failure. You call his cardiologist who tells you he has a “chronic troponin leak.” Should you be concerned to send this patient home?

CAD is the primary cause of death in ESRD. These patients have high pretest probability for ACS, increased severity of disease (more disease with less stenosis), and worse outcomes with an ischemic event. Elevated Trop I in ESRD patients show a 2- to 5-fold increase in mortality. These patients are high risk for mortality and appropriate for admission.