The role of cardiac markers in the emergency department
1Department of Emergency Medicine, University of Cincinnati College of Medicine, OH 45267-0769, USA. alan.storrow@uc.edu
Insights
Emergency department cardiac marker testing aids in diagnosing acute coronary syndromes (ACS) and acute myocardial infarction (AMI). Point-of-care testing and chest pain centers improve timely evaluation and risk stratification for these critical cardiac conditions.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Diagnostics
Background:
- Traditional emergency department (ED) evaluation for acute coronary syndromes (ACS) relies on history, physical exam, and ECG.
- Cardiac marker testing significantly impacts treatment decisions and risk stratification for suspected acute myocardial infarction (AMI).
- Advancements in sensitive myocardial necrosis markers have refined understanding of the ACS spectrum.
Purpose of the Study:
- To highlight the evolving role of cardiac marker testing in ED evaluations for ACS.
- To emphasize the impact of newer diagnostic tools and therapeutic agents on ACS management.
- To underscore the importance of serial cardiac marker assessment in ED chest pain centers.
Main Methods:
- Review of current practices in ED evaluation of potential ACS.
- Discussion of the influence of novel cardiac biomarkers and antiplatelet therapies.
- Analysis of the utility of bedside, point-of-care testing and ED-based chest pain centers (CPCs).
Main Results:
- Cardiac markers are crucial for risk stratification and influence treatment decisions beyond traditional methods.
- Point-of-care testing offers potential for faster diagnosis and treatment initiation in the ED.
- ED-based CPCs increasingly utilize serial cardiac marker testing for low- to moderate-risk patients.
Conclusions:
- Serial cardiac marker assessment and interpretation by emergency physicians are becoming essential for managing patients with chest pain.
- The integration of advanced diagnostics and therapeutics is transforming ACS care within the emergency setting.
- ED observation units and CPCs are centralizing the evaluation of patients with potential ACS, emphasizing the role of cardiac markers.
Abstract:
The emergency department (ED) evaluation of patients with potential acute coronary syndromes (ACS) has traditionally included initial cardiac marker testing for suspected acute myocardial infarction (AMI). While ED management decisions for patients with ACS have largely been based on history, physical examination, and a presenting 12-lead electrocardiogram (ECG), there is ample evidence that markers impact treatment decisions and provide risk stratification. Newer, more sensitive markers of myocardial necrosis have blurred the distinction between patients with and without classically defined AMI, and have focused attention on the continuum of ACS from angina to transmural Q-wave MI. Newer antiplatelet agents, the glycoprotein IIb/IIIa receptor 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-risk for ACS and a non-diagnostic ECG. Such centers use serial cardiac marker testing as a mainstay for evaluation and risk stratification. Cost issues have driven many diagnostic patient evaluations from the inpatient setting to such ED observation units. As this becomes more common for low- to moderate-risk patients with chest pain, serial assessment of cardiac markers, and their interpretation by emergency physicians, will become essential.
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