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May 4, 1984

Failure to Diagnose Acute Myocardial Infarction

Author Affiliations

University of Massachusetts Medical School St Vincent Hospital Worcester

JAMA. 1984;251(17):2208. doi:10.1001/jama.1984.03340410019013

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To the Editor.—  In "Failure to Diagnose Acute Myocardial Infarction," Zarling and colleagues presented an instructive experience. While I have little doubt about the facts and the objectivity of the individual numbers reported, I am mildly disturbed about the design of the report. In the introduction they state, "In the usual environment of clinical practice... the diagnosis of acute myocardial infarction... often is not made promptly or indeed before death." This implies that they already had access to the autopsy findings, although this conclusion is first ascribed to "casual observation." More importantly, the percentages given are quite unrealistic when comparing their groups. One hundred percent diagnostic accuracy in class I for noncardiological medical subspecialists actually represents only two of two cases, and a figure of 33% represents one of three cases. To express these as percents is unrealistic. Indeed, only nine cases each were seen by the subspecialists and by