American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Lab Tests Don’t Make Diagnoses, Doctors Do

During the last 10 years, I have been involved in a process that sought to create a clinical definition of myocardial infarction that could and would be used universally by clinicians and clinical investigators throughout the world. The impetus for this task was the observation that clinicians in different hospitals, and even within the same hospital, were employing different criteria to identify and categorize patients with acute and/or healed myocardial infarction. The confusion that resulted from these differing definitions of myocardial infarction is obvious. Moreover, different clinical trials involving therapeutic interventions for patients with myocardial infarction were defining the disease differently, thus making it difficult to compare results from one trial with those from another investigation since the patient populations studied differed in the 2 trials.

The first American College of Cardiology/European Society of Cardiology task force published its recommendation for a universal definition of myocardial infarction in 2000. This new definition was based on measurement of the highly sensitive and specific biomarker of myocardial necrosis, troponin. This first attempt at creating a universal definition of myocardial infarction was largely successful, with cardiologists around the world adopting the new criteria. Unfortunately, the new definition also proved problematic for some physicians because abnormal blood troponin levels can and do occur as a result of any process capable of injuring myocardium.

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— Joseph S. Alpert, MD
This article was originally published in the February 2008 issue of American Journal of Medicine.

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