Regular paperImpact of troponin T determinations on hospital resource utilization and costs in the evaluation of patients with suspected myocardial ischemia☆
Section snippets
Study population
The study protocol was approved by the Bridgeport Hospital Institutional Review Board. After informed consent was obtained from the patient, 10 ml of blood was collected within 20 minutes after arrival for cardiac markers. The sample size necessary to show a 20% reduction in resource utilization and costs with 90% power was calculated to be 776 patients based on financial data from our institution. The study was carried out on 891 patients who presented to the ED between September 1997 and
Results
Of the 891 patients randomized to the study, 856 patients met the inclusion criteria and comprised the study group. Thirty-five patients were excluded for the following reasons: end-stage renal disease (6 patients), presence of ST elevation on the admitting ECG (25 patients), or multiple cardioversions or defibrillations in the ED (4 patients). Control patients underwent a standard clinical and electrocardiographic evaluation with serial CK-MB determinations (447 patients), whereas TnT patients
Discussion
This study validates the recent acknowledgment of cardiac troponins as the new standard for detection of myocardial necrosis16, 17 in a broad spectrum of patients with suspected myocardial ischemia (even when CK-MB is considered the gold standard). Previous studies have focused mainly on high-risk patients presenting with chest pain to the ED,6, 7, 8 whereas fewer studies have focused on low-risk patients.9, 10 As approximately one third of patients with AMI do not have chest pain at
Acknowledgements
We would like to acknowledge the help of Michael Cordone and Mark Markarian in helping coordinate data management.
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2003, Revista Espanola de Cardiologia
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This study was supported by a grant from Roche Diagnostics, Indianapolis, Indiana.