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August 3, 1984

Failure to Diagnose Myocardial Infarction

Author Affiliations

Saint Joseph Hospital Kansas City, Mo

JAMA. 1984;252(5):625-626. doi:10.1001/jama.1984.03350050017010

To the Editor.—  In discussing why clinicians missed 47% of 100 consecutive autopsy-proved acute myocardial infarctions, Zarling and coauthors1 list four reasons, the first of which is "unjustified dependence on misleading laboratory studies." This statement is itself misleading, since it is a conclusion not supported by the authors' biochemical findings.The authors use biochemical strategies for which there is no support in standard texts of laboratory medicine or scientific articles. Major reliance was placed on individual SGOT, total lactic dehydrogenase (LDH), and total creatine kinase (CK) results. We are expected to accept that their numerical criteria were developed from "a previous unpublished study in our institution." Moreover, we are assured that "these enzyme levels were considered diagnostic of myocardial infarction only if there was an absence of other enzyme-elevating pathological conditions." We are not told how these critically important "absences" were established, except that the patients all received autopsies