RSS Feeds
Critical Pathway for Chest Pain
- Thomas H. Lee, MD; and
- Graham Nichol, MD
- Partners Community Health Care, Inc.; Boston, MA 02199 University of Ottawa; Ottawa, Ontario K1Y 4E9, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We appreciate that evidence of the potential role of rapid bedside testing in patients with chest pain in the emergency department is rapidly evolving. Dr. Bosch cites a non-experimental study of use of troponin-T and troponin-I. However, negative test results were insufficient to rule out short-term risks in all subgroups.
The other studies that he cites are worth considering further. Lindahl and colleagues assessed troponin T in patients with crescendo angina or ischemia on electrocardiography. The sensitivity of troponin T was overestimated because testing was conducted up to 24 hours after symptom onset. Furthermore, another prospective study [1] found that the sensitivity of troponin I and creatine kinase-MB were not significantly different when serum sampling was performed within 24 hours of symptom onset.
Ravkilde and colleagues enrolled patients with suspected myocardial infarction into a cohort study of markers of ischemia. Insufficient information was available to compare these patients to our own, but most were at much higher risk for myocardial infarction. Therefore, these results may not be generalizable.
Finally, Antman and colleagues prospectively assessed troponin I levels in patients with unstable angina or non-Q-wave myocardial infarction. Because the sensitivity and specificity of a test may vary with the prevalence of disease, the role of testing with troponin I or troponin T in patients at low risk for myocardial ischemia remains unclear [2].
We agree that evidence-based practice be revised in light of new information.
Thomas H. Lee, MD
Partners Community Health Care, Inc.; Boston, MA 02199
Graham Nichol, MD
University of Ottawa; Ottawa, Ontario K1Y 4E9, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
