Causes
Clinical
features
Investigations
Therapy
Prognosis
|  | | | Investigations |
Patients at low-risk for a myocardial infarction can be assessed in a
rapid evaluation unit b 
by
- CK-MB at 0, 4, 8, 12 h
- serial 12-lead ECGs
- clinical assessment at 0, 6, 12 h
- exercise ECG: if all the above negative
Why?
Patients at low-risk for a MI who have no CK-MB
rise or further pain within 12 hours are unlikely to have one
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI) |
Post-test Probability |
LR-
(95% CI) |
Post-test Probability |
| low-risk for MI a
(pre-test probability: 7%) |
myocardial infarction
(typical change in cardiac enzymes or cardiac
arrest) |
cardiac enzyme rise or recurrent chest pain within 12 hours |
6.8
(5.7 to 8.1) |
34% |
0.069
(0.027 to 0.18) |
0.5% |
- Patients admitted to a rapid assessment unit are not clearly less
likely to be diagnosed with a myocardial infarction or unstable angina
d
but spend on average 40 hours less in hospital. d
- Half of patients are still admitted to hospital (45%:
95% CI: 34% to 56%). a
|
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