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ER Physicians Perceive Evolving MI Patients as High Risk

These patients appear similar at presentation to those with non-ST elevation myocardial infarction

FRIDAY, July 25 (HealthDay News) -- Physicians usually perceive patients with evolving myocardial infarction (EMI) as high risk and give them similar treatment to patients presenting with non-ST elevation myocardial infarction, according to an article published in the August issue of the Emergency Medicine Journal.

Chadwick D. Miller, M.D., of Wake Forest University in Winston-Salem, N.C., and colleagues conducted a study of 4,136 patients who presented with undifferentiated chest pain and who had at least two troponin test results no more than 12 hours apart.

In all, 5 percent of the sample were diagnosed with EMI based on a negative first and positive second troponin assay; 8 percent were diagnosed with non-ST elevation myocardial infarction, based on an initial positive troponin assay; and the remaining 87 percent had no myocardial infarction, based on two negative assays. The demographic characteristics, presentation and patterns of admission and revascularization were similar for both EMI and non-ST elevation myocardial infarction, the researchers report.

"Most patients with EMI (76 percent) were initially stratified as acute myocardial infarction, unstable angina or high-risk chest pain," the authors write. "Importantly, the increased risk assessment was linked to more aggressive admission patterns and was not overshadowed by negative troponin results. Although this finding does not change practice, it does verify current practice patterns and suggests that emergency physicians should continue to use other clinical information in combination with cardiac markers when performing risk assessment."

Some of the study's authors disclosed financial ties to several pharmaceutical companies.

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