Is There a Need for Additional Means of Recognizing Myocardial Necrosis?

One might logically question whether there is a need for additional techniques to recognize the presence of acute myocardial infarcts in patients. Traditionally, the ECG and serum measurement of cardiac enzymes have been used to detect the presence or absence of acute myocardial necrosis resulting from coronary artery disease. For recognizing acute myocardial infarcts, these techniques are adequate in many patients, providing an absolute differentiation between the presence of acute myocardial infarction and other coronary artery disease syndromes, including angina pectoris and acute myocardial ischemia. However, there are subgroups of patients who come to the hospital with chest pain, in whom it is difficult to determine with accuracy whether they have had acute myocardial infarcts when just the ECG and cardiac enzymes are used alone. In particular, patients who arrive at the hospital 16 or more hours after the onset of chest pain, those with conduction abnormalities on their ECG.