NDLI: Biochemical markers in the management of suspected acute myocardial infarction in the emergency department.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Huggon, A. M. Chambers, J. Nayeem, N. Tutt, P. Crook, M. Swaminathan, S.
Spatial Coverage	England
Description	Author Affiliation: Huggon AM ( Department of Accident and Emergency, Guy's and St Thomas' Hospitals, London. amhuggan@hotmail.com)
Abstract	OBJECTIVES: To compare cardiac troponin T, myoglobin, CK, CKMB activity, CKMB mass and the initial electrocardiogram in the early diagnosis of myocardial infarction in the emergency department. Methods-Biochemical markers were measured at presentation in patients with a possible diagnosis of acute myocardial infarction. Based on the clinical notes, patients were grouped as 'definite myocardial infarction' (n = 50), 'definite no myocardial infarction' (n = 81) and 'uncertain' (n = 96). Sensitivity and specificity and positive and negative predictive values were calculated using the 131 patients with definitely present or absent myocardial infarction. RESULTS: The initial electrocardiogram was more sensitive than any of the markers in the first six hours from symptom onset-sensitivity 74% (95%CI 61% to 88%). The positive predictive value of the initial electrocardiogram was 97% in the first six hours; the markers ranged from 47% to 67%. The negative predictive value of the initial electrocardiogram was 85% in the first six hours; the markers ranged from 61% to 70%. Four patients with non-diagnostic electrocardiograms presenting beyond six hours after pain onset had a myocardial infarct detected by at least three of the biochemical markers in each case. CONCLUSIONS: The electrocardiogram is of more diagnostic use than biochemical markers in the first six hours after the onset of pain, but biochemical markers give additional positive diagnostic information in patients presenting later than this. The negative predictive accuracy of biochemical markers is too low for a single sample to be useful for excluding myocardial infarction in the first six hours after onset of symptoms.
File Format	HTM / HTML
ISSN	14720205
e-ISSN	14720213
Journal	Emergency Medicine Journal
Issue Number	1
Volume Number	18
Language	English
Publisher	BMJ Publishing Group Ltd
Publisher Date	2001-01-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Emergency Discipline Medicine Creatine Kinase Blood Emergency Service, Hospital Isoenzymes Myocardial Infarction Diagnosis Myoglobin Troponin T Creatine Kinase, Mb Form Electrocardiography Enzymology Predictive Value Of Tests Retrospective Studies
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Critical Care and Intensive Care Medicine

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