The authors report no conflicts of interest that could have affected the conduct of the trial, or that compromise the reporting or interpretation of its results.
The Effect of Cardiac Troponin Testing on Clinical Care in a Veterans Population
A Randomized Controlled Trial
Version of Record online: 9 JUN 2005
Journal of General Internal Medicine
Volume 20, Issue 7, pages 584–592, July 2005
How to Cite
Berkwits, M., Localio, M. A. R. and Kimmel, S. E. (2005), The Effect of Cardiac Troponin Testing on Clinical Care in a Veterans Population. Journal of General Internal Medicine, 20: 584–592. doi: 10.1111/j.1525-1497.2005.0111.x
- Issue online: 9 JUN 2005
- Version of Record online: 9 JUN 2005
- Accepted for publication January 12, 2005
- cardiac enzymes;
- cardiovascular diseases;
- acute coronary syndromes;
- chest pain
Background: Cardiac troponin is more accurate than creatine kinase (CK) testing for detecting myocardial injury in patients with acute coronary syndromes (ACS), but its effects on clinical care compared with CK testing alone is open to question.
Objective: To test the effects of troponin I on medical decisions for patients undergoing cardiac enzyme testing.
Design: Randomized, controlled trial.
Setting: Urban academic Veterans Affairs medical center.
Patients: Three hundred ninety-two patients presenting to the emergency department (ED) and outpatient settings with symptoms and/or electrocardiograms suggestive but not diagnostic of ACS.
Intervention: Random assignment to linked CK-troponin I (CKTnI) testing or CK testing alone.
Measurements: ED discharge and cardiac catheterization incidence (primary); ED medication use, inpatient noninvasive testing, revascularization procedures, discharge medications, and 8-week ED visits, hospitalizations, and procedures (secondary).
Results: Groups were similar in all variables except history of heart failure (CK 26.8% vs CKTnI 17.0%). ACS comprised 12.2% of the cohort. ED discharge incidence was greater in the CKTnI arm (18% vs 9.6%; relative risk [RR], 1.83; 95% CI, 1.08 to 3.31; P=.02; number needed to test=12.6; 95% CI, 4.5 to 130). Troponin testing had no significant effect on catheterization incidence (18.2% vs 14.5%; RR, 1.19; 95% CI, 0.72 to 1.92; P>.20) or other outcomes except follow-up echocardiography (13.4% vs 7.4%; RR, 2.24; 95% CI, 1.11 to 4.69; P=.02).
Conclusions: In a veterans population undergoing cardiac enzyme testing, CKTnI testing led to more ED discharges than CK testing alone but had no effect on inpatient care and was associated with more echocardiograms in a follow-up period.