Diagnosing myocardial infarction

doi:10.1136/bmj.323.7325.1366

BMJ 2001;323:1366 ( 8 December )

Letters

Diagnosing myocardial infarction

Randomised controlled trial and economic evaluation of a chest pain unit are in progress

Additional tools may help to identify patients at low risk

Randomised controlled trial and economic evaluation of a chest pain unit are in progress

The first 150 words of the full text of this article appear below.

EDITOR $---$ Acute chest pain is an important, but neglected, problem in the United Kingdom.¹ Emerging diagnostic approaches,such as the use of ST segment monitoring in emergency departments,new cardiac markers, and chest pain units have been extensivelyinvestigated in the United States.^2-4 Yet evaluation in the UnitedKingdom has progressed little beyond audit. Herren et al shouldtherefore be congratulated for embarking on rigorous evaluationof this problem.⁵ The protocol they describe has impressivediagnostic performance for myocardial infarction. There are, however,several reasons why we cannot assume that this will lead to improvedpatient care and costeffectiveness.

Assessment of acute chest pain requires more than simply ruling out myocardial infarction. Chest pain units in the UnitedStates typically provide provocative cardiac testing to stratifytheir patients further by risk. Immediate exercise stress testingis feasible in British emergency departments and is provided topatients within six . . . [Full text of this article]

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BMJ 2001 323: 372. [Abstract] [Full Text] [PDF]