Letter

Diagnosing myocardial infarction

BMJ 2001; 323 doi: 10.1136/bmj.323.7325.1366 (Published 8 December 2001)
Cite this as: BMJ 2001;323:1366

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

  1. Steve Goodacre, health services research fellow (s.goodacre@sheffield.ac.uk),
  2. Francis Morris, consultant in accident and emergency medicine,
  3. Stephen Campbell, consultant cardiologist,
  4. Deborah Quinney, research fellow,
  5. Simon Capewell, chair of clinical epidemiology
  1. Medical Care Research Unit, University of Sheffield, Sheffield S1 4DA
  2. Northern General Hospital, Sheffield S5 7AU
  3. Department of Public Health, University of Liverpool, Liverpool L69 3BG
  4. 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 …

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