Diagnosing myocardial infarction

doi:10.1136/bmj.323.7325.1366

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ comment articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

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

Steve Goodacre, health services research fellow (s.goodacre@sheffield.ac.uk),
Francis Morris, consultant in accident and emergency medicine,
Stephen Campbell, consultant cardiologist,
Deborah Quinney, research fellow,
Simon Capewell, chair of clinical epidemiology

Medical Care Research Unit, University of Sheffield, Sheffield S1 4DA
Northern General Hospital, Sheffield S5 7AU
Department of Public Health, University of Liverpool, Liverpool L69 3BG
Chest Pain Evaluation Unit, St Joseph Mercy Hospital, Pontiac, MI 48321, USA

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 extensively investigated in the United States.2-4 Yet evaluation in the United Kingdom has progressed little beyond audit. Herren et al should therefore be congratulated for embarking on rigorous evaluation of this problem.5 The protocol they describe has impressive diagnostic performance for myocardial infarction. There are, however, several reasons why we cannot assume that this will lead to improved patient care and cost effectiveness.

Assessment of acute chest pain requires more than simply ruling out myocardial infarction. Chest pain units in …