Article Abstract

Clinical, organizational and economic analysis of high-sensitivity cardiac troponin testing in the emergency department

Authors: Giuseppe Lippi, Laura Bonfanti, Mariella Dipalo, Rosalia Aloe, Gianfranco Cervellin


Background: Although high-sensitivity (HS) cardiac troponin I (cTnI) immunoassays have enhanced efficiency for early rule-out of acute coronary syndrome (ACS) compared to contemporary-sensitive (CS) techniques, no reliable information has been published in support of their cost-effectiveness. Therefore, this study was designed to evaluate the clinical, economic and organizational advantages of using a HS-cTnI immunoassay compared to a conventional CS-cTnI technique for early management of patients admitted to the emergency department (ED) with suspected ACS.
Methods: The study population consisted of 288 consecutive patients admitted to the ED for suspected ACS over a 3-month period. cTnI was measured with both HS-cTnI and CS-cTnI immunoassays. The clinical, economic and organizational impact was analyzed according to patient management based upon results of either method.
Results: ACS could be rapidly ruled out in a larger number of patients using HS-cTnI than CS-cTnI (68.7% versus 52.4%). The overall stay in the ED for ACS diagnostics was nearly 20% shorter using HS-cTnI than using CS-cTnI (1.9±1.4 versus 2.4±1.5 hour/patient; P<0.001). The mean cost for patient management in the ED was 128±92€ using HS-cTnI compared to 160±99€ with CS-cTnI (–20%; P<0.001)
Conclusions: The results of this study suggest that replacing CS-cTnI with HS-cTnI immunoassays may be effective for enhancing the efficiency of early rule-out of ACS, but also generates a favourable organizational and economic impact in the ED.