The current literature supports the inclusion of myocardial marker measurements in protocols governing the ED evaluation of patients with chest pain for four distinct purposes (Table.""). First, for the ability of myocardial markers to confirm or "rule in" suspected MI within the first hours after presentation in patients with nondiagnostic ECGs. Second, for the ability of markers to identify some patients with otherwise unrecognized MI from among the many patients with atypical presentations and non-diagnostic ECGs. Third, to risk-stratify patients early in their ED course—i.e., to identify those patients at particularly high risk for subsequent adverse events. Fourth, to definitively exclude the diagnosis of AMI using an accelerated myocardial marker curve during an extended observation and monitoring period in the ED. The first three applications are discussed here, while the fourth is discussed in the following section.
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