More rapid biochemical diagnosis of myocardial infarction: necessary? Prudent? Cost effective?
The need to improve the accuracy and rapidity of the triage and management of patients with chest discomfort has led to investigations of whether urgent measurements of markers of myocardial iijury can lead to the diagnosis of acute myocardial infarction more rap- idly ( 1-3). Enthusiasm for this strategy has been facilitated by the development of rapid analytical techniques. The rationale for this approach is predicated on the fact that only 25-30% of the roughly 5 million patients who present
... atients who present with chest discomfort eventually are proven to have infarction (4-6). Early identification of the subset with acute infarction might improve treatment and reduce complications. Conversely, identification of a lower-risk group without infarction might ensure more cost-effective utilization of hospital beds and protect physicians from liability for the discharge of patients with chest pain who subsequently have poor outcomes, a leading cause of malpractice litigation (7). Pursuit of this strategy has spawned articles attempting to document the usefulness of this approach, including the current paper by Collins et al. evaluating the use of creatine kinase (CK; EC 184.108.40.206) isoenzyme MB to determine which patients should be treated with thrombolytic agents (1). However, it is stifi unclear that the difficulties associated with this tactic have been adequately considered.