Impact of troponin T determinations on hospital resource utilization and costs in the evaluation of patients with suspected myocardial ischemia

The evaluation and triage of patients with suspected myocardial ischemia in the emergency department remains challenging and costly. Previous studies of cardiac troponins have focused predominately on patients with chest pain and have not randomized patients to different diagnostic strategies. Eight hundred fifty-six patients with suspected myocardial ischemia were prospec tively randomized to receive a standard evaluation, including serial electr ocardiographic and creatine phosphokinase-MB determinations (controls) or a standard evaluation with the addition of serial troponin T determinations (troponin group). The primary end points were length of stay and hospital c harges. Significant reductions in length of hospital stay were seen in trop onin T patients both with (3.6 vs 4.7 days; p = 0.01) and without (1.2 vs 1 .6 days; p = 0.03) acute coronary syndromes compared with controls. Total h ospital charges were reduced in a similar fashion in troponin patients with and without acute coronary syndromes ($15,004 vs $19,202; p = 0.01, and $4 ,487 vs $6,187; p = 0.17, respectively) compared with controls. Troponin pa tients without acute coronary syndromes had fewer hospital admissions (25% vs 31%; p = 0.04), whereas troponin patients with acute coronary syndromes had shorter telemetry and coronary care unit lengths of stay (3.5 vs 4.5 da ys; p = 0.03) compared with controls. Thus, utilization of troponin T in a broad spectrum of emergency department patients with suspected myocardial i schemia improves hospital resource utilization and reduces costs. (C) 2001 by Excerpto Medica, Inc.