Why the study?
Does the measurement of four biochemical markers improve the early diagnosis of acute MI in patients presenting to the emergency department with chest pain?
Does the measurement of four biochemical markers improve the early diagnosis of acute MI in patients presenting to the emergency department with chest pain?
Using a panel of four biochemical markers improves the early diagnosis of acute MI compared to CK-MB alone and may help identify low-risk patients suitable for early discharge.
May support multi-marker panels for earlier MI detection in the ED; hypothesis-generating and requires prospective validation before practice change.
Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.
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Ellestad et al. (2000) studied this question.
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