Cost-efficiency of myocardial contrast echocardiography in patients presenting to the emergency department with chest pain of suspected cardiac origin and a nondiagnostic electrocardiogram.

Abstract

Assessment of patients presenting to the emergency department (ED) with suspected cardiac chest pain and a nondiagnostic electrocardiogram (ECG) is lengthy and costly. It was hypothesized that myocardial contrast echocardiography (MCE) can be cost-efficient in such patients by detecting those with chest pain that is noncardiac in nature. Accordingly, cost-efficiency was evaluated in 957 patients presenting to the ED with suspected cardiac chest pain, but no ST-segment elevation on the ECG, who underwent MCE. Economic outcome calculations were based on costs estimated from national average Medicare charges adjusted by a cost-charge ratio. Based on routine clinical criteria, 641 patients (67%) were admitted to the hospital, whereas 316 (33%) were discharged directly from the ED. The average cost per patient using routine evaluation was $5,000. Patients with normal MCE results (n = 523) had a very low primary event rate (death, acute myocardial infarction) of 0.6% within 24 hours after presentation, making it relatively safe to discharge patients directly from the ED with a normal MCE result. Hence, if MCE had been used for decision making, 523 patients (55%) would have been discharged directly from the ED and 434 (45%) would have been admitted to the hospital. Preventing unnecessary admissions and tests would have saved an average of $900 per patient, in addition to reducing their ED stay. In conclusion, by excluding cardiac causes in patients presenting to the ED with chest pain and a nondiagnostic ECG, MCE can prevent unnecessary admissions and downstream resource utilization, making it a cost-efficient tool in the evaluation of these patients.