Background and objective: The assessment of patients with acute chest pain according to the risk of cardiac involvement takes time and expensive tests. This study was undertaken to evaluate whether the measurement of troponin 1 (Tnl) would reliably recognize those patients with an increased risk of cardiac disease so that unnecessary hospital stay could be avoided or at least reduced.
Patients and methods: A qualitative rapid test for Tnl was performed, at emergency admission and 4 hours later, on the blood of 812 consecutive patients with acute left-chest pain of < or = 12 hours' duration. Admission was decided on the basis of clinical symptoms, ECG findings and CK-MB results. All cardiac events (death, myocardial infarction) within the next 30 days were recorded for all patients.
Results: Of the 812 patients (56% males; average age 62 +/- 12 years) 65% were admitted. At a daily cost of DM 635 and a mean duration of stay of 4.2 days, the total costs were DM 173,000 per 100 evaluated patients. None of the patients with a negative Tnl test and normal or ECGs that were not interpretable regarding ischaemic signs had cardiac events during the follow-up period of 30 days. By restricting hospitalization to patients with positive Tnl test and/or ST-T changes in the ECG a cost reduction of up to 14% could be achieved (P < 0.01). The cost of the Tnl test (DM 18) would be covered by reducing the number of admitted patients by about 2.1%.
Conclusion: Performance of two Tnl tests is a cost-effective way of assessing the risk of cardiac events in patients with acute left-chest pain.