Is it time to drop the 10 hour troponin from NICE chest pain guidance?

NICE chest pain guidance is due for review in 2013. When the guidance was developed there was insufficient evidence relating to high-sensitivity troponin to make recommendations, but since then the evidence has increased. We therefore undertook an economic analysis to determine the cost-effectiveness of different troponin testing strategies for patients with suspected myocardial infarction. The results, published in the October issue of Heart, suggest that the NICE recommendation that troponin should be measured 10 hours after symptom onset does not promote cost-effective care. In most of the scenarios we studied the additional costs incurred by 10 hour troponin testing did not represent value for money for the quality-adjusted years of life gained, compared to high sensitivity troponin testing at presentation. Amendment of NICE guidance to recommend presentation or 3 hour troponin testing instead of 10 hour testing could substantially reduce chest pain admissions, with an associated reduction in pressure on acute beds and consequent cost savings.

Steve Goodacre

Thokala P, Goodacre SW, Collinson PO, Stevens JW, Mills NL, Newby DE, MorrisF, Kendall J, Stevenson MD. Cost-effectiveness of presentation and delayed troponin testing for acute myocardial infarction. Heart 2012;98:1498-1503 doi:10.1136/heartjnl-2012-302188