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Hours after Chest Pain Onset

Hours after Chest Pain Onset

-Myoglobin ----MB isoforms —o— CK-MB —*— Troponin T —a— Troponin I

Fig. 2. Relative marker increase over time. Adapted with permission from Newby LK, Christenson RH, Ohman EM. Role of troponin and other markers of myocardial necrosis in risk stratification. In: Topol EJ, ed. Acute Coronary Syndromes. Marcel Dekker, New York, 1998, pp. 405-435.

cover all needs efficiently. Because of the superiority of these markers (alone or in combination), lactate dehydrogenase (LDH) has largely fallen out of use as a marker of myocardial necrosis. The in-laboratory assay times for all of these markers are within 15-20 min, and bedside assays are available for most.

Although the use of cardiac markers (including bedside assays) in chest pain patients has been shown to be of prognostic importance, and Downie and colleagues (49) showed that in the CCU setting, bedside assessment of myocardial necrosis was feasible and allowed for more rapid management decisions, the question remains whether point-of-care testing can measurably shorten ED evaluation time. In their study of point-of-care testing of routine chemistries in the ED, Parvin and colleagues (50) found no significant difference in ED length of stay through physician use of bedside point-of-care testing, even after adjusting for differences in presenting conditions. Further study of the effect of point-of-care testing of cardiac markers on ED length of stay, rapidity of treatment decisions, and, ultimately, outcome vs standard testing will be needed.

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