title: Cost-effectiveness of cardiac biomarkers as screening test in acute chest pain.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Samad
authors.initials: S
authors.lastname: Shams-Vahdati
authors.affiliation: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Vand-Rajavpour
authors.affiliation: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Seyed-Pouya
authors.initials: SP
authors.lastname: Paknezhad
authors.affiliation: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Piri
authors.affiliation: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Elnaz
authors.initials: E
authors.lastname: Moghaddasi-Ghezeljeh
authors.affiliation: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Saba
authors.initials: S
authors.lastname: Mirabolfathi
authors.affiliation: Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Naghavi-Behzad
keywords: Acute Chest Pain; Cardiac Biomarkers; Creatine Kinase-MB; Myocardial Infarction
references.citation: Ann Emerg Med. 2005 Aug;46(2):185-97
references.pmid: 16046952
references.citation: Clin Chem. 1998 Jul;44(7):1430-6
references.pmid: 9665420
references.citation: Clin Chem. 1999 Feb;45(2):199-205
references.pmid: 9931041
references.citation: Acad Emerg Med. 1994 Jan-Feb;1(1):17-27
references.pmid: 7621148
references.citation: Clin Res Cardiol. 2011 Mar;100(3):209-15
references.pmid: 20852870
references.citation: J Am Coll Cardiol. 1997 Jul;30(1):133-40
references.pmid: 9207634
references.citation: Circulation. 1994 Jul;90(1):583-612
references.pmid: 8026046
references.citation: Eur Heart J. 1996 Jul;17(7):1028-34
references.pmid: 8809520
references.citation: J Am Coll Cardiol. 2007 Nov 27;50(22):2173-95
references.pmid: 18036459
references.citation: Ann Emerg Med. 1990 Dec;19(12):1359-66
references.pmid: 2240745
references.citation: Heart. 2012 Sep;98(17):1326; author reply 1326
references.pmid: 22705930
references.citation: J Cardiovasc Thorac Res. 2013;5(1):23-8
references.pmid: 24251005
references.citation: N Engl J Med. 1997 Dec 4;337(23):1648-53
references.pmid: 9385123
references.citation: JAMA. 2003 Nov 5;290(17):2277-83
references.pmid: 14600186
references.citation: Ann Emerg Med. 1999 Jan;33(1):15-21
references.pmid: 9867882
references.citation: Ann Clin Lab Sci. 1996 Jul-Aug;26(4):291-300
references.pmid: 8800429
references.citation: CMAJ. 2005 Nov 8;173(10):1191-202
references.pmid: 16275971
references.citation: J Am Coll Cardiol. 1998 Jul;32(1):8-14
references.pmid: 9669242
references.citation: J Cardiovasc Thorac Res. 2013;5(1):5-9
references.pmid: 24251002
references.citation: Adv Data. 2006 Jun 23;(372):1-29
references.pmid: 16841785
references.citation: Int J Cardiol. 2006 Sep 10;112(1):21-6
references.pmid: 16837084
references.citation: Circulation. 2010 Jun 1;121(21):2294-301
references.pmid: 20479153
references.citation: J Cardiovasc Thorac Res. 2012;4(4):95-101
references.pmid: 24250995
references.citation: Clin Chem. 1996 Nov;42(11):1770-6
references.pmid: 8906075
references.citation: Arch Intern Med. 1997 May 26;157(10):1085-91
references.pmid: 9164374
references.citation: J Am Coll Cardiol. 2003 Nov 5;42(9):1547-54
references.pmid: 14607436
references.citation: Circulation. 2001 Sep 25;104(13):1483-8
references.pmid: 11571240
references.citation: J Cardiovasc Thorac Res. 2013;5(2):73-5
references.pmid: 24251016
references.citation: BMJ. 2000 Jun 24;320(7251):1702-5
references.pmid: 10864545
references.citation: Clin Chem. 1986 Apr;32(4):657-63
references.pmid: 3955814
references.citation: Clin Chem. 2008 Jan;54(1):24-38
references.pmid: 18160725
references.citation: J Am Coll Cardiol. 2008 Jan 22;51(3):307-14
references.pmid: 18206741
references.citation: Am Heart J. 1999 Feb;137(2):332-7
references.pmid: 9924168