Abstract 16310: A Third Troponin Sample is Neither Cost-Effective Nor Necessary in Patients Suspected of Acute Coronary Syndrome With First Two Negative Troponins
Introduction: Chest pain patients account for approximately 8% to 10% of the 119 million Emergency department visits yearly in the United States. Troponin is the most sensitive and specific test for myocardial damage and is released in 2-4 hours after chest pain and persists for up to 7 days. At Abington Hospital Jefferson Health, the Architect Stat Troponin I chemiluminescent micro particle assay (CIMA), a high sensitivity test is used to test troponin at admission, 4 and 8 hours after admission.
Hypothesis: To determine the incidence of the third troponin sample being positive in patients suspected of acute coronary syndrome given the first two sets of troponin were negative.
Methods: After approval from the Institutional Review Board, a retrospective observational chart review of chest pain patients of age more than 16 admitted to Abington Hospital from July 1st 2014 to June 30th 2015 was conducted. A total of 333 patients with chest pain were identified. Patients admitted for elective cardiac catheterization were excluded as were the patients who were admitted with another diagnosis and developed chest pain during the hospitalization.
Results: Mean age of the study subjects was 64± 10.5 years and 47% were female. Of the 333 chest pain visits, 93.1 % (310) had all three negative troponins, 5.7 % (19) had all three positive troponins, 1.2% (4) had the second and third positive troponin. None of the subjects had only the third positive troponin. Mean hospital stay was found to be 1.69 days with median of 1.0 and the mean and median of cost of stay was 23,936 and 14,664 US dollars respectively. The number of patients whose length of stay was extended solely because of the third sample of troponin was 310. Incremental cost of the third blood sample: [310 patients х $30 USD per cTnT analysis] + [310 patients х $14,665] = $4,555,450 USD.
Conclusion: A third troponin sample adds no vital information regarding patients ‘management plan’. On the contrary, it leads to unnecessary extension of hospital stay and cumulative cost.
Author Disclosures: R. Azad: None. S. Collins: None. M. Cohen: None.
- © 2016 by American Heart Association, Inc.