On the basis of thrombolysis in myocardial infarction (TIMI) score, ECG, and a point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin, Martin Than and colleagues(1) identified patients with chest pain who were at very low risk of a short-term major adverse cardiac event and who might be suitable for early discharge.
We are a little concerned about missing TIMI score data. The score includes “three or more risk factors for coronary artery disease” and “significant coronary stenosis at previous angiography” (yes=1, no=0). We wonder whether a patient without a regular health check was regarded by Than and colleagues as scoring 0 or 1? This could be an important issue considering the threshold considered (TIMI score ≥1=positive). We know, for instance, that people of low socioeconomic status have a lower access to health care, yet they have more risk factors for coronary heart disease.(2—4) Without a regular check-up, these people might have had a lower TIMI score than they should have.
In conclusion, we think that the accelerated diagnostic protocol should take into account the absence of medical follow-up to consider factors such as health inequalities.
We declare that we have no conflicts of interest.
References
1 Than M, Cullen L, Reid CM, et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet 2011; 377: 1077-1084. Summary | Full Text | PDF(200KB) | CrossRef | PubMed
2 Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993; 88: 1973-1998. PubMed
3 Tyroler HA. The influence of socioeconomic factors on cardiovascular disease risk factor development. Prev Med 1999; 29: S36-S40. CrossRef | PubMed
4 Manrique-Garcia E, Sidorchuk A, Hallqvist J, Moradi T. Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis. J Epidemiol Community Health 2011; 65: 301-309. PubMed
Tuesday
Serum Myoglobin
Serum myoglobin is a test that measures the amount of myoglobin in the blood.
Myoglobin is a protein in heart and skeletal muscles. When you exercise, your muscles use up any available oxygen. Myoglobin has oxygen attached to it, which provides extra oxygen for the muscle to maintain a high level of activity for a longer period of time.
When muscle is damaged, myoglobin is released into the bloodstream. Ultimately, it is removed in the urine.
Myoglobin is a protein in heart and skeletal muscles. When you exercise, your muscles use up any available oxygen. Myoglobin has oxygen attached to it, which provides extra oxygen for the muscle to maintain a high level of activity for a longer period of time.
When muscle is damaged, myoglobin is released into the bloodstream. Ultimately, it is removed in the urine.
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