The objective of this survey was to estimate the proportion of episodes of acute coronary syndromes (ACS) without ST segment elevation in relation to the total number of acute chest pain presentations. We attempted to estimate costs associated with glycoprotein (GP) IIb/IIIa inhibitor treatment in patients with high-risk features.
This was a prospective survey set in a typical British district general hospital, serving a population of about 300,000. It took place over a 14-week period.
The participants were all patients presenting with chest pain of possible cardiac origin, identified by intensive surveillance of all emergency medical admissions (EMAs) in patients over 16 years of age and all adult and elderly medicine in-patients. At the time of the study, the upper limit of normal for troponin T (TnT) used in this hospital was 0.05 µg/L.
The main outcome measures were: the proportion of EMAs due to chest pain of likely cardiac origin; the number of episodes of ACS without ST elevation as a proportion of all EMAs; and the projected prescribing costs of GPIIb/IIIa inhibitor treatment for high-risk cases.
We found that 22% (CI 20.07–23.5%) of all EMAs were due to chest pain likely to be of cardiac origin. One event of ACS without ST elevation was generated for every 25.6 (CI 23.8–28.6) EMAs. Using a TnT value of > 0.1 µg/L to define high risk and suitability for GPIIb/IIIa inhibitor treatment, a minimum of 66% of patients with ACS without ST elevation would be eligible for treatment. In the study hospital, this translates to an annual cost of £131,000 (equivalent to £43,600 per 100,000 catchment population) or £11.45 per all-cause hospital EMA.
In conclusion, about two thirds of patients with ACS without ST elevation have high-risk features and would potentially benefit from treatment with GPIIb/IIIa inhibitors. The costs of drug treatment are appreciable, but financial planning can be assisted by the data presented here.
For UK healthcare professionals only