An international found that doctors do a good job of aggressively treating the early stages of heart attacks – even before laboratory tests confirm// the diagnosis. The study involved 467 hospitals spread across 12 countries.

“There has always been a concern that patients may be treated less aggressively when they present with heart attack symptoms before laboratory tests are able to confirm the diagnosis,” said Chadwick Miller, M.D., lead author and an emergency medicine physician at Wake Forest University School of Medicine. “But these findings suggest doctors are doing an appropriate job of aggressively treating these patients.”

Results from the research, which included more than 8,000 patients, are reported on-line in the European Heart Journal and will appear in a future print issue.

Laboratory testing is one tool used by doctors to confirm whether a patient is experiencing a heart attack. The tests measure levels of the protein troponin, which increase when there is damage to the heart muscle. However, it can take six to eight hours after symptoms begin for these markers to increase.

“These tests are also used by doctors to determine which therapies would benefit the patient the most,” said Miller. “Those with elevated markers are at higher risk, and more aggressive treatments are warranted. But, in patients who come to the emergency department immediately after their symptoms begin, it can be difficult to determine if they are having a heart attack. This uncertainty could lead to delay in treatment.”

The study compared results among three groups of patients: those with initially normal levels of troponin that became elevated within the next 12 hours – and were considered to be having an “evolving” heart attack; those whose markers were elevated at the time of the evaluation and were diagnosed with a heart attack; and those whose markers did not become elevated within 12 hours.

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