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The ratpac trial
Acute myocardial infarction is a diagnosis that no clinician wants to miss. The Randomised Assessment of Treatment Using Panel Assay of Cardiac Markers (RATPAC) trial was a multicentre randomised controlled trial undertaken in six acute hospitals in the UK. The focus of the study was to examine the use of point-of-care cardiac biomarkers (including creatinine kinase, myocardial type, myoglobin and troponin I) in patients presenting with chest pain at initial presentation and again at 90 min. It was encouraging to read that the use of the panel of point-of-care testing was found to be capable of increasing the proportion of patients who are discharged from the emergency department but, disappointingly, it did not alter the mean length of stay or hospital days (Heart 2011;97:190–6).
Staying with matters of the heart, a prospective observational study from the USA attempted to ascertain whether cardiology electrocardiogram (ECG) reviews would decrease the error in ECG interpretation and treatment error. The abnormal ECG of eligible patients with chest pain were faxed through to a cardiology fellow who then independently …