title: The utility of four biochemical markers in the triage of chest pain patients.
abstract: Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.
authors.affiliation: Memorial Heart Institute, Long Beach, CA 90801-1428, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Ellestad
authors.forename: R
authors.initials: R
authors.lastname: Startt-Selvester
authors.forename: E
authors.initials: E
authors.lastname: Stanton
authors.forename: B
authors.initials: B
authors.lastname: VanNatta
authors.forename: J
authors.initials: J
authors.lastname: Ahmad
authors.forename: Y
authors.initials: Y
authors.lastname: Gawad
authors.forename: F
authors.initials: F
authors.lastname: Swiger
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis; D009211:Myoglobin / Q000097:blood*; D018994:Myosin Light Chains / Q000097:blood*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014218:Triage; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D018994:Myosin Light Chains; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form