Accelerated coronary reperfusion through the use of rapid bedside cardiac markers

Each year, acute myocardial infarctions (AMI) account for more than half a million deaths in the United States. Complicating treatment of AMI is the d ifficulty in accurately diagnosing the event, for patients have nondiagnost ic electrocardiograms (ECG) more than 50% of the time. In this population, cardiac markers are essential to confirm the diagnosis. The new bedside car diac markers, which use eight drops of whole blood and require 15 minutes t o be read negative, make it possible to shorten time needed to diagnose AMI . One hundred twenty-seven consecutive patients presented to the emergency department complaining of atypical chest pain. All had ECGs that were nondi agnostic for myocardial infarction. Serial cardiac markers were performed: myoglobin, troponin I, rapid myoglobin, and rapid troponin I. One hundred e ighteen patients with negative serial cardiac markers had exercise treadmil l tests in the emergency department. Nine patients with positive serial car diac markers received emergent primary angioplasty. Six of the nine patient s were treated based on the positive results of the rapid bedside cardiac m arkers. A 100% correlation existed between the quantitative serum results a nd the rapid bedside markers. With the availability of rapid bedside assays , dependency on the laboratory can be minimized, since quantitative cardiac markers require at least 1 hour of turnaround time. Rapidly and correctly diagnosing AMIs in patients with ECGs nondiagnostic for AMI has always been a dilemma. Rapid bedside assays enable the physician to accurately diagnos e myocardial infarction and safely decrease the time in evaluating chest pa in, thus maximizing the benefits of early reperfusion.