Low yield of rule-out myocardial infarction protocol in patients presenting with syncope

Abstract

Syncope is a common complaint that often requires hospital admission. 1 Kapoor W.N. Karpf M. Wieand S. Peterson J.R. Levey G.S. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983; 309: 197-204 Crossref PubMed Scopus (702) Google Scholar , 2 Kapoor W.N. Syncope. N Engl J Med. 1983; 343: 1856-1862 Crossref Scopus (348) Google Scholar In the admitted patient, multiple tests are performed to ascertain the cause of syncope. A frequent test ordered is the “rule-out” myocardial infarction (MI) protocol, consisting of 3 serial electrocardiograms and measurements of myocardial cardiac enzymes (creatine phosphokinase [CPK] and CPK-MB fractionation). We hypothesized that unselected use of the rule-out MI protocol for patients admitted with syncope is not only unwarranted, but frequently performed, and thus costly to the health care system. To evaluate this hypothesis, we reviewed the hospital records of all patients admitted through the emergency department of our institution with a diagnosis of syncope or near-syncope (near loss of consciousness) from July of 1996 through June of 1997.