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Markers of Myocardial Injury in the Evaluation of the Emergency Department Patient with Chest Pain

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Part of the book series: Pathology and Laboratory Medicine ((PLM))

Abstract

In recent years, the approach used in the evaluation of the emergency department (ED)* patient with suspected myocardial ischemia has undergone dramatic changes. Data-gathering, treatment, and disposition patterns that had been accepted for decades are now being intensely scrutinized and often abandoned in favor of assessment protocols based on new diagnostic technologies (1). Foremost among these new technologies are the many new methods for the laboratory measurement of markers of myocardial injury.

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References

  1. The Cardiology Roundtable (1994) Perfecting MI ruleout. Best practices for emergency evaluation of chest pain. The Advisory Board Company, Washington, D.C.

    Google Scholar 

  2. American Heart Association (1987) Heart Facts. American Heart Center, Dallas, TX.

    Google Scholar 

  3. McCaig LF (1994) National hospital ambulatory medical care survey: 1992: emergency department summary. Adv. Data 245:12.

    Google Scholar 

  4. Singer DE, Carr PL, Mulley AG, and Thibault GE (1983) Rationing intensive care—physician responses to a resource shortage. N. Engl. J. Med. 309:11,155-11,160.

    Article  Google Scholar 

  5. Selker HP, Griffith JL, Dorey FJ, and D’Agostino RB (1987) How do physicians adapt when the coronary care unit is full? JAMA 257,1181–1185.

    Article  PubMed  CAS  Google Scholar 

  6. Schor S, Behar S, Modan B, Barell V, Drory J, and Kariv I (1976) Disposition of presumed coronary patients from an emergency room: a follow-up study. JAMA 236:941–943.

    Article  PubMed  CAS  Google Scholar 

  7. Green GB, Hansen KN, Chan DW, and Guerei AD, Fleetwood DH, Sivertson KT, and Kelen GD (1991) The potential utility of a rapid CK-MB assay in evaluating emergency department patients with possible myocardial infarction. Ann. Emerg. Med. 20:954–960.

    Article  PubMed  CAS  Google Scholar 

  8. Tierney WM, Fitzgerald J, McHenry R, Roth BJ, Psaty B, Stump DL, and Anderson FK (1986) Physicians’ estimates of the proba-bility of myocardial infarction in emergency room patients with chest pain. Med. Decis. Making 6:12–17.

    Article  PubMed  CAS  Google Scholar 

  9. Hedges J, Rouan GW, Toltzis R, Goldstein-Wayne B, and Stein EA (1987) Use of cardiac enzymes identifies patients with acute myocardial infarction otherwise unrecognized in the emergency department. Ann. Emerg. Med. 16:248–252.

    Article  PubMed  CAS  Google Scholar 

  10. Lee TH, Rouan G, Weisberg M, Brand DA, Acampora D, Stasinlewicz C, Walshonk J, Terranova G, Gottlieb L, Goldstein-Wayne B, Copen D, Daley K, Brandt A, Mellors J, Jakubowski R, Cook EF, and Goldman L (1987) Patients with acute MI sent home from the emergency room. Am. J. Cardiol. 60:219–224.

    Article  PubMed  CAS  Google Scholar 

  11. Goldman L, Cook EF, Brand DA, Lee TH, Rouan GW, Weisberg MC, Acampora D, Stasinlewicz C, Walshon J, Terranova G, Gottlieb L, Kobernick M, Goldstein-Wayne B, Copen D, Daley K, Brandt AA, Jones D, Mellors J, and Jakubowski R (1988) A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N. Engl. J. Med. 318: 797–803.

    Article  PubMed  CAS  Google Scholar 

  12. Zarling EJ, Sexton H, and Milnor P (1983) Failure to diagnose acute myocardial infarction: the clinicopathologic experience at a large community hospital. JAMA 250: 1171–1181.

    Article  Google Scholar 

  13. Rusnack RA, Stair TO, Hansen D, and Fastow JS (1989) Litigation against the emergency physician: Common features in cases of missed myocardial infarction. Ann. Emerg. Med. 18:1029–1034.

    Article  Google Scholar 

  14. Diagnosis of the doubtful coronary [editorial]. 1982. Lancet 1:661–662.

    Google Scholar 

  15. Lee TH, Cook EF, and Weisberg M (1985) Acute chest pain in the emergency room: identification and examination of low-risk patients. Arch. Intern. Med. 145:65–69.

    Article  PubMed  CAS  Google Scholar 

  16. Eisenberg JM, Horowitz LN, Busch R, Arvan D, Rawnsley H (1979) Diagnosis of acute myocardial infarction in the emergency room: A prospective assessment of clinical decision marking and the usefulness of immediate cardiac enzyme determination. J. Commun. Health 4:190–198.

    Article  CAS  Google Scholar 

  17. Green GB, Chan DW, Chandra NC, Pietrzak MP, and Sayers DG (1991) Role of the laboratory in the diagnosis of myocardial injury. Crit. Care Rep. 2:318–330.

    Google Scholar 

  18. Wu AHB (1997) Use of cardiac markers as assessed by outcomes analysis. Clin. Biochem. 30:339–350.

    Article  PubMed  CAS  Google Scholar 

  19. Tierney MW, Roth BJ, and Psaty B (1985) Predictors of myocardial infarction in emergency room patients. Crit. Care Med. 13:526–531.

    Article  PubMed  CAS  Google Scholar 

  20. Pozen MW, D’Agostino RB, Mitchell JB (1985) The usefulness of a predictivbe instrument to reduce inappropriate admissions to the coronary care unit. Ann. Intern. Med. 92:238–242.

    Google Scholar 

  21. Braunwald E, Mark DB, Jones RH, Cheitlin MD, Fuster V, McCauley KM, et al. (1994) Unstable angina: diagnosis and management. Clinical practice guidelines number 10 (amended) AHCPR publication no. 94-0602. Rockville, MD, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, Public Health Service, US Department of Health and Human Services, Rockville, MD, May.

    Google Scholar 

  22. Smith EE, Braen GR, Cantrill SV, Dalsey WC, Fesmine FM, Green CS, Karas S, Leibovich M, Mackey D, Molzen GW, and Murphy BA (1995) Clinical policy for the initial approach to adults presenting with a chief complaint of chest pain, with no history of trauma. Ann. Emerg. Med. 25:274–299.

    Article  Google Scholar 

  23. Shesser R and Smith M (1994) The chest pain emergency department and the outpatient chest pain evaluation center: Revolution or evolution? Ann. Emerg. Med. 23: 334–341.

    CAS  Google Scholar 

  24. Hoekstra JW, Gibier WB, Levy RC, Sayre M, Naber W, Chandra A, Kacich R, Magorien R, and Walsh R (1994) Emergency-department diagnosis of acute myocardial infarction and ischemia: A cost analysis of two diagnostic protocols. Acad. Emerg. Med. 1:103–110.

    Article  PubMed  CAS  Google Scholar 

  25. Gibier WB, Lewis LM, Erb RE, Makens PK, Kaplan BC, Vaughn RH, Biagini, AV, Blanton JD, and Campbell WB (1990) Early detection of acute myocardial infarction in patients presenting with chest pain and non-diagnostic ECGs: Serial CK-MB sampling in the emergency department. Ann. Emerg. Med. 19:1359–1366.

    Article  Google Scholar 

  26. Marin MM and Teichman SL (1992) Use of rapid serial sampling of creatine kinase MB for very early detection of myocardial infarction in patients with acute chest pain. Am. Heart J. 123:354–361.

    Article  PubMed  CAS  Google Scholar 

  27. Gibier WB, Young GP, Hedges JR, Lewis LM, Smith MS, Carleton SC, Aghababian RV, Jorden RO, Allison ES, Otten EJ, Makens PK, and Hamilton C (1992) The Emergency Medicine Cardiac Research Group: Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: Serial CK-MB sampling in the emergency department. Ann. Emerg. Med. 21:504–512.

    Article  Google Scholar 

  28. Gibier WB, Gibier CD, Weinshenker E, Abbottsmith C, Hedges JR, and Barsan WG (1987) Myoglobin as an early indicator of acute myocardial infarction. Ann. Emerg. Med. 16:851–856.

    Article  Google Scholar 

  29. Tucker JF, Collins RA, Anderson RA, Hess M, Farley IM, and Hagemann DA (1994) Value of serial myoglobin levels in the early diagnosis of patients admitted for acute myocardial infarction. Ann. Emerg. Med. 24:704–708.

    Article  PubMed  CAS  Google Scholar 

  30. Hedges JR, Gibier WB, Young GP, Hoekstra JW, Slovis C, Aghababian R, and Smith M (1996) Multicenter study of creatine kinase— MB Use: Effect on chest pain clinical decision making. Acad. Emerg. Med. 3:7–15.

    Article  PubMed  CAS  Google Scholar 

  31. Hedges JR, Young GP, Henkel GF, Gibier WB, Green TR, and Swanson JR (1994) Early CK-MB elevations predict ischemic events in stable chest pain patients. Acad. Emerg. Med. 1:9–16.

    Article  PubMed  CAS  Google Scholar 

  32. Hoekstra JW, Hedges JR, Gibier WB, Robison RM, and Christensen RA (1994) Emergency department CK-MB: A predictor of ischemic complications. Acad. Emerg. Med. 1:17–28.

    Article  PubMed  CAS  Google Scholar 

  33. Hamm CW, Ravkilde J, Gerhardt W, Jorgensen P, Peheim E, Ljungdahl L, Goldmann B, Katus HA (1992) The prognostic value of serum troponin T in unstable angina. N. Engl.J. Med. 327:146–150.

    Article  PubMed  CAS  Google Scholar 

  34. Wu A, Abbas SA, Green S, Pearsall P, Dhakam S, Azar R, Onoroski M, Senaie A, McKay R, and Waters D (1995) Prognostic value of cardiac troponin T in unstable angina pectoris. Am. J. Cardiol. 76:970–972.

    Article  PubMed  CAS  Google Scholar 

  35. Lee TH, Juarez G, Cook F, Weisberg MC, Rouan GW, Brand DA, and Goldman L (1991) Ruling out acute myocardial infarction: A prospective multicenter validation of a 12-hour strategy for patients at low risk. N. Engl. J. Med. 324:1239–1246.

    Article  PubMed  CAS  Google Scholar 

  36. Gaspoz JM, Lee TH, Cook F, Weisberg MC, and Goldman L (1991) Outcome of patients who were admitted to a new short-stay unit to rule out myocardial infarction. Am. J. Cardiol. 68:145–149.

    Article  PubMed  CAS  Google Scholar 

  37. Gibier WB, Runyon JP, Levy RC, Sayre MR, Kacich R, Hattemer CR, Hamilton C, Grlach JW, and Walsh RA (1995) A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann. Emerg. Med. 25:1–8.

    Article  Google Scholar 

  38. Hoekstra JW, Gibier WB, Levy RC, Sayre M, Naber W, Chandra A, Kacich R, Magorien R, and Walsh R (1993) Emergency department diagnosis of acute myocardial infarction and ischemia: A cost analysis [Abstract]. Ann. Emerg. Med. 22:941.

    Google Scholar 

  39. Graff L, Joseph T, and Andelman R (1995) American College of Emergency Physicians Information Paper: Chest Pain Units in Emergency Departments—A Report from the Short-Term Observation Services Section. Am. J. Cardiol. 76:1036–1039.

    Article  PubMed  CAS  Google Scholar 

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© 1998 Springer Science+Business Media New York

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Green, G.B., Green, S.F. (1998). Markers of Myocardial Injury in the Evaluation of the Emergency Department Patient with Chest Pain. In: Wu, A.H.B. (eds) Cardiac Markers. Pathology and Laboratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-1806-7_4

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  • DOI: https://doi.org/10.1007/978-1-4612-1806-7_4

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-7292-2

  • Online ISBN: 978-1-4612-1806-7

  • eBook Packages: Springer Book Archive

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