Strategic utilization of cardiac markers for the diagnosis of acute myocardial infarction.

Current changes of the healthcare environment have promoted the creation of chest pain centers in the emergency departments for rapid triage of patients admitted for cardiac evaluation. Because of the inefficiency of electrocardiogram for the diagnosis of acute myocardial infarction, blood cardiac markers play an important role in the decision making process. Current commercial cardiac tests available include creatine kinase, its MB isoenzyme, MB isoforms, lactate dehydrogenase and its isoenzyme-1, myoglobin, cardiac troponin T and troponin I. The diagnostic efficacy of each of these assays is reviewed. Their appropriate use depends on when the specimens are collected for testing after the onset of myocardial infarction. Since not all patients seek medical attention at the time symptoms appear, the applicability of these markers differs in each case. Based on the time after the onset of chest pain, a utilization strategy of the cardiac markers is proposed. With this protocol, the triage of patients can be optimized resulting in the efficient treatment of patients and large savings in cost.