Historical Review of Acute Myocardial Ischemia Risk Assessment.

The specialty of emergency medicine has emphasized the importance of the rapid diagnosis and treatment of time-dependent conditions. Recognition of the emergency patient at high risk for myocardial ischemia is one such condition. In collaboration with cardiologists and laboratory medicine specialists, emergency physicians have revolutionized the approach to diagnosing patients at risk for myocardial ischemia in the emergency department. This article provides a historical viewpoint based upon the authors' practice and research in myocardial ischemia risk recognition beginning in the 1980s, along with the work of selected researchers in the field to describe an evolving understanding of the underlying pathophysiology, the application of serial laboratory diagnostic techniques, and resultant goal-directed multidisciplinary care of the at-risk patient. Such an approach lends itself to the clinical assessment of patients in a multicultural, multiethnic environment as seen in Hawai'i. The evolution of acute myocardial ischemia risk assessment through emergency medicine research is detailed, including (a) the recognition of the limitations of patient discomfort subjective language descriptors, (b) the incorporation of highly specific and sensitive laboratory biomarkers for MI, and (c) the use of mechanistically-driven, serial clinical and laboratory assessments. Today's objective emergency approach to acute myocardial ischemia risk assessment is relevant to cross-cultural applications, as is required for medical care in the Pacific Basin.