Routine serum enzyme tests in the diagnosis of acute myocardial infarction. Cost-effectiveness

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Abstract
To determine the cost-effectiveness of routine use of serial SGOT [serum glutamic oxaloacetic transaminase], 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 were 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 (i.e., 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 $10,038 or .apprx. $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.