The role of cardiac markers in the emergency department

The emergency department (ED) evaluation of patients with potential acute c oronary syndromes (ACS) has traditionally included initial cardiac marker t esting for suspected acute myocardial infarction (AMI). While ED management decisions for patients with ACS have largely been based on history, physic al examination, and a presenting 12-lead electrocardiogram (ECG), there is ample evidence that markers impact treatment decisions and provide risk str atification. Newer, more sensitive markers of myocardial necrosis have blur red the distinction between patients with and without classically defined A MI, and have focused attention on the continuum of ACS from angina to trans mural Q-wave MI. Newer antiplatelet agents, the glycoprotein IIb/IIIa recep tor blockers, are likely to receive increased ED utilization. This use will be partially driven by ED cardiac marker determination. Bedside, point-of- care testing is reliable technology that may shorten time to diagnosis and treatment of ACS in the emergency setting. The ED-based chest pain center ( CPC) has become a popular tool to evaluate patients at low- to moderate-ris k for ACS and a nondiagnostic ECG. Such centers use serial cardiac marker t esting as a mainstay for evaluation and risk stratification. Cost issues ha ve driven many diagnostic patient evaluations from the inpatient setting to such ED observation units. As this becomes more common for low- to moderat e-risk patients with chest pain, serial assessment of cardiac markers, and their interpretation by emergency physicians, will become essential. (C) 19 99 Elsevier Science B.V. All rights reserved.