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Invited Commentary |

Myocardial Infarction Rule-out in the Emergency Department: Are High-Sensitivity Troponins the Answer?  Comment on “One-Hour Rule-out and Rule-in of Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin T”

L. Kristin Newby, MD, MHS
Arch Intern Med. 2012;172(16):1218-1219. doi:10.1001/archinternmed.2012.1808.
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Triage of emergency department (ED) patients with possible acute myocardial infarction (MI) without ST-segment elevation remains one of the most challenging dilemmas in medical practice. The stakes are high: patients with MI inappropriately sent home have approximately 2-fold higher risk-adjusted 30-day mortality than those hospitalized.1 Conversely, it is not feasible or cost-efficient to admit all patients for MI “rule-out.” The advent of chest pain units diminished the strain on in-patient resources,2 but even these units often use serial electrocardiograms (ECGs) and cardiac marker testing over 6 to 9 hours to confidently confirm or exclude MI. With increasing ED overcrowding, more effective tools are needed to enable rapid triage of patients with possible MI. In addition, although time dependency of treatment for non–ST-segment elevation MI (non-STEMI) is uncertain, earlier diagnosis could lead to more effective use of acute therapies and more efficient, shorter hospital stays.

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