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May 4, 1984

Failure to Diagnose Acute Myocardial Infarction

JAMA. 1984;251(17):2207. doi:10.1001/jama.1984.03340410019010

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To the Editor.—  The article written by Zarling and associates entitled "Failure to Diagnose Acute Myocardial Infarction" discussed the specialty of the responsible physician with respect to missing the diagnosis. They state that "among the non-internal medicine specialists, the diagnostic accuracy in class I was 0%." The definition of class I was "typical retrosternal chest pain with confirmatory enzymatic and/or ECG findings."When inspecting Table 3 included in the referenced article, we noted that there were no patients in class I for this group; therefore, the calculation of 0/0=0% is misleading. Another interpretation is that there was 100% accuracy in this group and, while no myocardial infarctions with "typical presentations" were missed by non-internal medicine physicians, the internists missed three of 27, or 11%.