S. Zarich et al., Impact of troponin T determinations on hospital resource utilization and costs in the evaluation of patients with suspected myocardial ischemia, AM J CARD, 88(7), 2001, pp. 732-736
Citations number
19
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
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.