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To the Editor.—
Dr. John S. LaDue's comment on "Elevated Heart Enzyme Levels in Apparent Absence of Myocardial Infarction" (227:808, 1974) contains an incorrect suggestion, namely, that elevated enzyme SGOT, SHBD, and CPK levels are specific for myocardial infarction when measured in a setting where myocardial infarction might occur.We studied 100 consecutive admissions to the coronary care unit. Each patient had an admitting diagnosis, "Rule out myocardial infarction." We measured total SGOT, SHBD, CPK, and LDH, as well as the isoenzymes of CPK and LDH, for ten consecutive days. Patients were divided into two groups, myocardial infarction and nonmyocardial infarction on the basis of history, serial electrocardiograms, and clinical judgment. We studied the frequency distribution of the results of these enzyme assays on each hospital day and found that the amount of overlap between the two groups of patients was too great to permit accurate diagnosis, even on days
Galen RS, Reiffel JA, Gambino SR. Enzymes in Infarction. JAMA. 1974;228(10):1229. doi:10.1001/jama.1974.03230350019015
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