Ruling Out Acute Myocardial Infarction

To the Editor: Lee et al. (May 2 issue) 1 are to be congratulated on their excellent paper, which shows the value of clinical decision making. However, there are complementary strategies for the rapid confirmation or exclusion of acute myocardial infarction within 8 to 12 hours after hospital admission. We have previously demonstrated 2 , 3 that the serial measurement of creatine kinase or its MB isoenzyme and calculation of the rate of increase over the eight hours after admission have high diagnostic value. Others have had similar results. 4 5 6 The accompanying editorial in the Journal 7 emphasizes the clinical progress of patients with chest pain . . .