Coronary Artery Disease and the Acute Coronary Syndrome

Tony J. DeMartini; Henry S. Loeb

doi:10.7326/0003-4819-139-11-200312020-00022-w1

Letters |2 December 2003

Coronary Artery Disease and the Acute Coronary Syndrome

Tony J. DeMartini, MD; Henry S. Loeb, MD

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TO THE EDITOR:

Background: Coronary artery disease and the acute coronary syndrome are difficult to identify in patients with an atypical history. A complete history and physical examination, in addition to electrocardiography and measurement of serum cardiac enzymes, contribute to the accurate diagnosis of the disease.

Cardiac enzymes used to identify myocardial damage have undergone an extensive transformation. In 1954, Karmen and colleagues used serum glutamic oxaloacetic aminotransferase and lactate dehydrogenase (LDH) as markers of myocardial infarction (1). Reliance on these enzymes is problematic because of low sensitivity and specificity. The sensitivity and specificity of the LDH isoenzymes increased when the LDH-1LDH-2 ratio was used (2). Dreyfus and colleagues described the use of creatine phosphokinase for the diagnosis of myocardial infarction in 1960 (3). Again, the use of creatine phosphokinase alone was hindered by decreased sensitivity and specificity, because many other disease processes can contribute to an elevated level as well. A 1972 report demonstrated a higher sensitivity and specificity of creatine phosphokinase when the MB isoenzyme was used (4).

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2003 American College of Physicians

Letters |2 December 2003

Coronary Artery Disease and the Acute Coronary Syndrome

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Letters |2 December 2003

Coronary Artery Disease and the Acute Coronary Syndrome

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