IMPACT OF EARLY SERUM CARDIAC MARKERS ON EVALUATION OF PATIENTS IN THE EMERGENCY DEPARTMENT - DIAGNOSIS AND RISK STRATIFICATION

Early serum markers represent an important diagnostic tool for detecti ng myocardial necrosis in patients presenting to the emergency departm ent with acute ischaemic coronary syndrome. Myoglobin, CK-MB and the t roponins I and T are sensitive indicators of acute myocardial infarcti on (AMI). The troponins are not only sensitive, but also extremely spe cific for myocardial injury. Recent studies suggest particular are val uable for risk stratification by identifying patients at high risk for future cardiac complications, such as AMI and death. Chest Pain Centr es have been developed which use early serum markers to identify AMI i n the emergency setting, allowing low-risk patients to undergo provoca tive testing within 9 hours after emergency department presentation. U ltimately, the use of early serum markers in the emergency department can Improve surveillance for patients with evolving transmural AMI req uiring thrombolytic therapy or acute mechanical intervention and ident ify patients with atypical AMI presentations to prevent release from t he emergency department Finally, early serum markers, as part of a Che st Pain Centre programme, can help to provide a comprehensive evaluati on of possible acute ischaemic coronary syndrome in the emergency sett ing as hospital admissions for such work-ups become less available due to managed care.