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Cost-effectiveness of cardiac biomarkers as screening test in acute chest pain
Samad Shams-Vahdati1, Zahra Vand-Rajavpour2, Seyed-Pouya Paknezhad2
1Department of Emergency Medicine, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Cardiac biomarkers are effective for screening acute chest pain, offering good specificity and sensitivity for diagnosing conditions like Acute Myocardial Infarction. Their cost-effectiveness supports their use in emergency settings.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Acute chest pain is a common symptom, often indicative of ischemic heart disease.
- Traditional cardiac biomarkers like Creatine Kinase-MB (CK-MB) have limitations in specificity and sensitivity.
- Electrocardiograph (ECG) findings in cardiac events are highly variable.
Purpose of the Study:
- To evaluate the cost-effectiveness of single quantitative measurements of cardiac biomarkers.
- To assess the diagnostic utility of troponin I and CK-MB in emergency settings.
- To determine the sensitivity and specificity of cardiac biomarkers for Acute Coronary Syndrome and Acute Myocardial Infarction.
Main Methods:
- A descriptive-analytic study was conducted on 2900 patients presenting with chest pain.
- Data collected included demographics, symptoms, ECG findings, and troponin I and CK-MB test results.
- Patients were recruited from the Emergency Unit of Tabriz Imam Reza educational-medical center.
Main Results:
- The study included 1440 males and 1460 females with a mean age of 62.91 years.
- Cardiac biomarkers showed a sensitivity of 44.8% and specificity of 86.6% for Acute Coronary Syndrome.
- For Acute Myocardial Infarction, sensitivity was 72.2% and specificity was 86%.
Conclusions:
- Cardiac biomarkers are valuable for screening patients with acute chest pain.
- The appropriate specificity and sensitivity of these biomarkers justify their use in emergency departments.
- Cost-effectiveness further supports the utility of cardiac biomarkers in acute chest pain management.
Introduction:
Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Associated findings of electrocardiograph (ECG) are rather heterogeneous, and traditional cardiac biomarkers such as Creatine Kinase-MB (CK-MB) suffer from low cardiac specificity and sensitivity. In this study cost effectiveness of cardiac biomarkers single quantitative measurement was examined.
Methods:
The present descriptive-analytic study conducted on patients who were asked for troponin I and CK-MB. All patients who referred to Emergency unit of Tabriz Imam Reza educational-medical center during January 2012 to July the 2013 were included in study. All patients included in the study were documented in terms of age, sex, working shift of referring, main complaint of patient, symptoms in referring, ECG findings, and results of troponin I and CK-MB tests.
Results:
In this study, 2900 patients were studied including 1440 (49.7%) males and 1460 (50.3%) females. Mean age of patients was 62.91 (SD=14.36). Of all patients 1880 (64.8%) of patients referred during 8 a.m. to 8 p.m. and 1020 (35.2%) patients were referred during 8 p.m. to 8 a.m. The sensitivity of cardiac biomarkers' test in diagnosing Acute Coronary Syndrome (ACS) disease was calculated as 44.8% and its specificity was 86.6%. For diagnosing Acute Myocardial Infarction (AMI), sensitivity of cardiac biomarkers' test was 72.2% and its specificity was 86%. None of patients who were finally underwent unstable angina diagnosis showed increase in cardiac enzymes.
Conclusion:
In conclusion, cardiac biomarkers can be used for screening acute chest pains, also cost effectiveness of cardiac biomarkers, appropriate specificity and sensitivity can guarantee their usefulness in emergency room.
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