Sensitivity of Routine Clinical Criteria for Diagnosing Myocardial Infarction Within 24 Hours of Hospitalization

doi:10.1059/0003-4819-106-2-181

Sensitivity of Routine Clinical Criteria for Diagnosing Myocardial Infarction Within 24 Hours of Hospitalization

THOMAS H. LEE, M.D.;
GREGORY W. ROUAN, M.D.;
MONICA C. WEISBERG, R.N.;
DONALD A. BRAND, Ph.D.;
E. FRANCIS COOK, ScD.;
DENISE ACAMPORA, M.P.H.; and
LEE GOLDMAN, M.D., M.P.H.

THE CHEST PAIN STUDY GROUP;
Boston, Massachusetts; New Haven, Danbury, and Milford, Connecticut; and Cincinnati, Ohio

Abstract

Myocardial infarction was diagnosed in 431 (30%) of 1460 patients with acute chest pain who had serial enzyme testing after admission to intensive or intermediate care units at three teaching and three community hospitals. The diagnosis was made within 12 hours of admission in 331 (77%) patients and within 24 hours in 415 (96%). Of the 16 patients with myocardial infarction who did not have enzyme abnormalities within 24 hours, 9 (56%) had recurrent ischemic pain during this 24-hour period. Of 451 patients who had neither enzyme abnormalities nor recurrent ischemic pain in the first 24 hours, only 7 (2%) ultimately met diagnostic criteria for myocardial infarction. These findings were prospectively validated in an independent testing set of 275 patients with myocardial infarction, 271 (99%) of whom either met diagnostic criteria for myocardial infarction or had recurrent ischemic pain within 24 hours of admission. These data suggest that 24 hours is nearly always a sufficient period to exclude myocardial infarction in patients without recurrent chest pain.

Article and Author Information

▸From the Brigham and Women's Hospital and Harvard Medical School, Boston. Massachusetts; Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut; University of Cincinnati Hospital and University of Cincinnati, Cincinnati, Ohio; Danbury Hospital, Danbury, Connecticut; Milford Hospital, Milford, Connecticut; and St. Mary's Hospital, Waterbury, Connecticut. Members of the Chest Pain Study Group and participating institutions are listed in the Acknowledgments.
Grant support: in part by grant 83102-2H from the John A. Hartford Foundation, New York, New York. Dr. Lee is the recipient of a Public Health Service Clinical Investigator Award (HLOl 594-01 ) from the National Heart, Lung, and Blood Institute. Dr. Goldman is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.
▸ Requests for reprints should be addressed to Lee Goldman, M.D., M.P.H.; Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street; Boston, MA 02115.