Combining necrosis and platelet markers for perfecting myocardial infarction rule out: How close are we?

Each year, at least 5 million patients in the United States present to hosp ital emergency departments with the complaint of chest pain, and more than 10% of them will be diagnosed with acute myocardial infarction. One of the foremost tasks of the emergency department physician is to avoid unnecessar y admissions and concomitantly to minimize the number of patients discharge d home inappropriately. Currently available diagnostic tools, including the electrocardiogram and myocardial markers, have several shortcomings, inclu ding low specificity, and delayed sensitivity for the timely detection of m yocardial necrosis. Therefore, the search for better methods of rapidly ide ntifying patients with unstable coronary syndromes is one of the utmost pri orities of modern emergency medicine. Available biochemical diagnostic tool s are discussed in this review, focusing on the potential benefits of combi ning myocardial necrosis markers with indicators of platelet activation. It is hypothesized that such a combined approach may be more powerful in myoc ardial infarction risk stratification than separate marker determination, C opyright (C) 2000 S. Karger AG, Basel.