Abstract 14155: Concomitant Use of Creatine Kinase MB and High-Sensitivity Troponin: What is the Cost?

Abstract

Introduction: AHA/ACC guidelines recommend the use of serial high sensitivity troponin (hs-Tn) assays to assess for cardiac injury 1 and addition of CK-MB adds no benefit. However, in the clinical setting, CK-MB assays continues to be ordered concomitantly with hs-Tn in evaluation of suspected myocardial injury/infarction. We performed this study to determine whether the addition of CK-MB to hs-Tn alters diagnostic or therapeutic decisions and to determine its effect on patient outcomes. The financial aspects of this practice were also analyzed Methods: We performed a retrospective review of patients in the Geisinger Health care system from 2018 through 2021. Those having both a CK-MB and a hs-Tn drawn within 24 hours were included. Test results were categorized as concordant or discordant. Patient demographics, clinical profiles, medications and rates of diagnostic cardiac catheterization and subsequent PCI and primary admission and discharge diagnosis were collected from the EMR and analyzed. We used Medicare reimbursement data for estimates of financial impact. Results: A total of 18,727 unique patients had a CK-MB and hs-Tn performed within a 24-hour window. Of these, 49.1% (9,149) had concordant values and 50.9% (9,533) had discordant values. Of those with discordant results, 8,801 (92.3%) patients had abnormal hs-Tn result but normal CK-MB. Abnormal CK-MB with a normal hs-Tn was resulted in 840 patients (8.8%). There was a total of 42,276 CK-MB determinations during our study timeframe which averages out to 2.3 CK-MB/patient. Medicare reimbursement for CKMB is $11.55. Conclusions: This 3-year study demonstrates clinicians still frequently ordered CKMB in patients with concomitant hs-Tn determinations and 49.1%% results are concordant with hs-Tn results yielding no additional clinical information versus use of hs-Tn alone. The cost of this practice is estimated at $239,749.31 for the study period. Data on patients with discordant results and impact on decision process and cost is under analysis and will be available for presentation.