Carísi A. Polanczyk, MD, MSc; Karen M. Kuntz, ScD; David B. Sacks, MB, ChB; Paula A. Johnson, MD, MPH; Thomas H. Lee, MD, ScD
Grant Support: Dr. Polanczyk is sponsored by a scholarship from CAPES, Brasilia, Brazil.
Requests for Reprints: Thomas H. Lee, MD, Partners Community HealthCare, Inc., Suite 1150, Prudential Tower, Boston, MA 02119; e-mail, firstname.lastname@example.org. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, email@example.com.
Current Author Addresses: Dr. Polanczyk: Hospital de Clinicas de Porto Allegre, Rua Ramiro Barcelos 2350/2228, Porto Allegre, Brazil 90000.
Dr. Kuntz: Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115.
Drs. Sacks and Johnson: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Dr. Lee: Partners Community HealthCare, Inc., Prudential Tower, Suite 1150, 800 Boylston Street, Boston, MA 02199-8001.
Polanczyk CA, Kuntz KM, Sacks DB, Johnson PA, Lee TH. Emergency Department Triage Strategies for Acute Chest Pain Using Creatine Kinase–MB and Troponin I Assays: A Cost-Effectiveness Analysis. Ann Intern Med. 1999;131:909-918. doi: 10.7326/0003-4819-131-12-199912210-00002
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Published: Ann Intern Med. 1999;131(12):909-918.
Several tests can assist clinicians in the evaluation of patients with acute chest pain, the most readily available of which are biochemical markers of myocardial damage and exercise testing. These tests are generally considered unnecessary in patients at very low risk for myocardial infarction, for whom immediate discharge from the emergency department is appropriate. However, they are commonly used in patients who are admitted to the hospital or held for several hours of observation because of suspected myocardial ischemia.
Until recently, the most widely used serum marker of myocardial damage was creatine kinase (CK) and its cardiac isoenzyme, CK-MB (1). However, several studies have shown that cardiac troponins can provide additional prognostic information in patients admitted to the emergency department with chest pain (2-6). We have reported analyses suggesting that routine use of cardiac troponin I should be restricted to patients who have normal CK-MB values and electrocardiograms that show new changes consistent with ischemia (7). However, neither this algorithm nor others (8, 9) have been evaluated for relative cost-effectiveness. In the absence of information about which of these biochemical markers should be used in which patients, clinicians frequently order both CK-MB and troponin I assays.
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Cardiology, Emergency Medicine, Acute Coronary Syndromes, Coronary Heart Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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