Cardiac Marker Point-Of-Care Testing in the Emergency Department and Cardiac Care Unit (Beckman Conference‪)‬

Four million chest pain patients are admitted each year for ruling out acute myocardial infarction (AMI). [1] Up to 70% of patients are admitted to the Cardiac Care Unit (CCU) for suspected AMI rule out (1), with estimates suggesting that two to three billion dollars per year could be saved caring for this population in a less intensive setting (2). However, AMI patients may present to the Emergency Department (ED) with normal or nondiagnostic electrocardiograms (ECGs) 50% of the time, making early diagnosis of AMI difficult (3). Up to 8% of AMI patients may be inadvertently discharged from the ED, and this subset of patients accounts for 20% of emergency medical malpractice dollar losses and leads to increased morbidity and mortality. (4, 5). Frequent misdiagnoses given to AMI patients inadvertently discharged from the ED include esophagitis, muscle strain, and exacerbation of chronic obstructive pulmonary disease. In a recent review of missed AMI closed malpractice claims, ~25% of missed AMI cases were because of ECG misinterpretation, in 25% of cases the ECG was correctly interpreted but the clinical importance of the ECG findings were not appreciated, and the remaining 50% had nondiagnostic ECGs and atypical symptom complexes (6).