RT Journal
A1 Newby L
T1 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”
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2012
FD September 10
VO 172
IS 16
SP 1218
OP 1219
DO 10.1001/archinternmed.2012.1808
UL http://dx.doi.org/10.1001/archinternmed.2012.1808
AB 
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.