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August 1983

Routine Serum Enzyme Tests in the Diagnosis of Acute Myocardial Infarction: Cost-Effectiveness

Author Affiliations

From the Veterans Administration Medical Center, the University of Maryland School of Medicine, and Union Memorial Hospital, Baltimore. Read in part before the national meeting of the American Federation of Clinical Research, Washington, DC, May 12, 1980.

Arch Intern Med. 1983;143(8):1541-1543. doi:10.1001/archinte.1983.00350080047012

• To determine the cost-effectiveness of routine use of serial SGOT, lactic dehydrogenase (LDH), and LDH isoenzyme determinations in patients with suspected acute myocardial infarction (AMI), 166 consecutive patients admitted to a coronary care unit were prospectively identified and clinical findings analyzed independently using predetermined criteria. Based on chest pain characteristics, ECG, and creatine kinase—MB (CK-MB) results, patients were placed in categories of definite AMI (31%), possible AMI (34%), or AMI excluded (36%). The SGOT and/or LDH patterns were considered positive (ie, suggestive of AMI) in 82% of the patients with definite AMI but only confirmed CK-MB results. Positive SGOT/LDH results yielded new clinically relevant information in only 14 patients (8%). Total charges for SGOT/LDH determinations in these 166 patients totaled $10,938 or approximately $780 for each additional clinically important positive result. When serial ECG and CK-MB results are available, routine serial SGOT/LDH determinations are not justified.

(Arch Intern Med 1983;143:1541-1543)