Impact of serum troponin measurement on triage of chest pain in a district hospital.

Abstract AIM: To evaluate the impact on the clinical service of incorporating cardiac troponin T (cTnT) measurement into the existing chest pain care pathway in our district general hospital. METHODS: We randomised 200 consecutive patients admitted with acute chest pain, but without ST elevation on ECG, either to our existing chest pain care pathway (pathway 1) or to a new pathway incorporating semi-quantitative cTnT measurement (pathway 2). RESULTS: In comparison with pathway 1, in pathway 2 there was a strong trend towards reduced length of stay (3.13 v 4.36 days, p=0.08), and reduced usage of low molecular weight heparin (LMWH) (4.59 v 5.45 doses per patient, p=0.05). The number of cardiac events at three months in care pathway 1 (14/92) and care pathway 2 (22/108) did not significantly differ, p=0.34. In patients with atypical chest pain, there was a tendency for cardiologists to discharge earlier (1.75 v 2.03 days, p=0.07) and use less LMWH (2.04 v 2.97 doses, p=0.06) than general physicians. CONCLUSION: In this study, incorporation of cTnT measurement into a chest pain care pathway resulted in a strong trend towards reduced length of hospital stay and LMWH usage.