Journal of General Internal Medicine

, Volume 20, Issue 7, pp 584–592

The effect of cardiac troponin testing on clinical care in a veterans population

A randomized controlled trial
  • Michael Berkwits
  • A. Russell Localio
  • Stephen E. Kimmel
Original Article

DOI: 10.1111/j.1525-1497.2005.0111.x

Cite this article as:
Berkwits, M., Localio, A.R. & Kimmel, S.E. J GEN INTERN MED (2005) 20: 584. doi:10.1111/j.1525-1497.2005.0111.x
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Abstract

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.

Key words

troponincardiac enzymescardiovascular diseasesacute coronary syndromeschest pain

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Michael Berkwits
    • 1
  • A. Russell Localio
    • 2
  • Stephen E. Kimmel
    • 2
    • 3
  1. 1.Philadelphia VA Medical Center and the Division of General Internal MedicineUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  2. 2.Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Cardiovascular Division, Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Blue Bell