Optimal diagnosis in acute myocardial infarction. A cost-effectiveness study.


The predictive value of a diagnostic test estimates the likelihood for presence or absence of disease in a patient with a positive or negative test result (PVpos or PVneg). We evaluated the predictive values of serum activities of the heart-specific creatine kinase isoenzyme MB (CK-MB), aspartate aminotransferase, lactate dehydrogenase, CK, and ECG in 401 consecutively admitted patients suspected of acute myocardial infarction (AMI). The study showed that CK-MB (PVpos = 0.98, PVneg = 1.00) was better than the other enzymes (single as well as serial) and ECG, evaluated both separately and in combinations. In all cases of AMI CK-MB was positive within 17 hours from admission. Replacement of the standard enzymes with CK-MB provides a faster and safer diagnosis of AMI and reduces hospitalization time considerably for patients without AMI.


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@article{Grande1980OptimalDI, title={Optimal diagnosis in acute myocardial infarction. A cost-effectiveness study.}, author={Peer Grande and Claus Christiansen and Ayako Wakatsuki Pedersen and Merete Sanvig Christensen}, journal={Circulation}, year={1980}, volume={61 4}, pages={723-8} }