This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hamm, C. W. Search for Related Content PubMed PubMed Citation Articles by Hamm, C. W.

(Circulation. 2001;104:1454.)
© 2001 American Heart Association, Inc.

Editorials

Cardiac Biomarkers for Rapid Evaluation of Chest Pain

Christian W. Hamm, MD

From the Kerckhoff Heart Center, Bad Nauheim, Germany.

Correspondence to Christian W. Hamm, MD, Kerckhoff Heart Center, Benekestrasse 2-8, D-61231 Bad Nauheim, Germany. E-mail Christian.Hamm@kerckhoff.med.uni-giessen.de

Key Words: Editorials • myoglobin • diagnosis • myocardial infarction • troponin

Physicians caring for acute chest pain patients constantly maneuver between unnecessary admissions and premature discharges. The ECG is the most readily available tool for identifying patients with ST-segment elevation, who are likely to have myocardial infarctions and who should receive reperfusion treatment. Establishing the correct diagnosis in the patients without ST-segment elevation, however, can be much more challenging. Undetected infarctions remain a serious public health issue and represent the leading cause of malpractice cases in the emergency room setting.¹ Prematurely discharged patients often have been seen by physicians with less professional experience. Such patients frequently have more atypical complaints and nondiagnostic ECG findings, are younger, and are at higher risk than admitted patients.^1,2

See p 1483

Ruling out acute myocardial infarctions, however, is an incomplete strategy according to today’s standards. The target has moved to risk stratification, with the objective being not only to detect evolving myocardial infarctions, but also to identify the patient who is at risk of developing a life-threatening cardiac event in the near future. For this task, the ECG has limited prognostic relevance because abnormalities are infrequent and are of low sensitivity and specificity. Only ST-segment depression, which is found in about one third of the patients, is associated with short- and long-term adverse outcome.^3,4

Biomarkers in the New Guidelines

In recent years, novel biochemical markers have emerged that play a pivotal role in diagnosis, risk stratification, and guidance of treatment. Markers of inflammation, such as C-reactive protein, have been found helpful in predicting the long-term prognosis, whereas the improved markers . . . [Full Text of this Article]

This article has been cited by other articles:

				B. L. Cucchiara, S. R. Messe, R. A. Taylor, J. Pacelli, D. Maus, Q. Shah, and S. E. Kasner Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack? Stroke, July 1, 2006; 37(7): 1710 - 1714. [Abstract] [Full Text] [PDF]

				A. S. Jaffe and H. Katus Acute Coronary Syndrome Biomarkers: The Need for More Adequate Reporting Circulation, July 13, 2004; 110(2): 104 - 106. [Full Text] [PDF]

				M. Panteghini Role and importance of biochemical markers in clinical cardiology Eur. Heart J., July 2, 2004; 25(14): 1187 - 1196. [Abstract] [Full Text] [PDF]

				P. Kaul, L. K. Newby, Y. Fu, V. Hasselblad, K. W. Mahaffey, R. H. Christenson, R. A. Harrington, E. M. Ohman, E. J. Topol, R. M. Califf, et al. Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk stratification of acute coronary syndrome patients J. Am. Coll. Cardiol., February 5, 2003; 41(3): 371 - 380. [Abstract] [Full Text] [PDF]