Ischemic heart disease remains the leading cause of death in the United States. Coronary atherosclerosis results in 1.5 million heart attacks per year, with approximately 500,000 deaths. Effective intervention is predicated on timely diagnosis of acute myocardial infarction (AMI).<sup>27 Gibler W.B., Runyon J.P., Levy R.C. , y al. A rapid diagnostic and treatment center for patients with chest pain in the emergency department Ann Emerg Med 1995 ;  25 : 1-8  [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 74 Tormey W.P. The diagnosis and management of acute myocardial infarction—a role for biochemical markers? Ann Clin Biochem 1996 ;  33 : 477-481

Haga clic aquí para ir a la sección de Referencias</sup> The World Health Organization definition of AMI requires two of the following three criteria: 1) presence of characteristic chest pain for a period of time; 2) diagnostic electrocardiogram (ECG) changes; and 3) typical rise and fall of serum levels of cardiac markers.<sup>43 Keffer J.H. Myocardial markers of injury Am J Clin Pathol 1996 ;  105 (3) : 302-320

Haga clic aquí para ir a la sección de Referencias, 85 Young G.P., Gibler W.B., Hedges J.R. , y al. Serial creatine kinase-MB results are a sensitive indicator of acute myocardial infarction in chest pain patients with nondiagnostic electrocardiograms: The second emergency medicine cardiac research group study Acad Emerg Med 1997 ;  4 : 869-877  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Approximately 5% of patients with AMI are released unintentionally from emergency departments (EDs), placing them at high risk for later morbidity and mortality.<sup>26 Gibler W.B., Lewis L.M., Erb R.E. , y al. Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECG: Serial CK-MB sampling in the emergency department Ann Emerg Med 1990 ;  19 : 1359-1366  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> This is because up to one fourth of patients with AMI present with atypical signs and symptoms. Electrocardiography (ECG) remains the most specific diagnostic tool, but about 40% of patients have nondiagnostic ECG changes at the time of admission.<sup>23 Foreback C.C. Biochemical diagnosis of myocardial infarction Henry Ford Hosp Med J 1991 ;  39 : 159-164

Haga clic aquí para ir a la sección de Referencias</sup> These limitations make clinical recognition of AMI difficult, and approximately 60% to 70% of patients admitted to the hospital because of chest pain eventually are discharged with a different diagnosis.<sup>47 Lee T.H., Juarez G., Cook E.F. , y al. Ruling out myocardial infarction: A prospective multicenter validation of a 12-hour strategy for patients at low risk N Engl J Med 1991 ;  324 : 1239-1246  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> The use of biochemical markers remains a cornerstone in the diagnosis of acute coronary syndromes.