Reducing hospitalizations for heart failure

finding as an event without practical implications? Having established that we need to revascularize the patients with a minimal risk of complications, including any CK-MB elevation, we must be aware that when the elevation is contained within a certain range (we still do not know the exact threshold but it appears to be around three or five times the normal value) the clinical impact of this event will be nil and difficult to see in the practice of each individual physician. As in most clinical conditions, the outcome is also dependent on a number of other clinical variables. For example, a different attitude should be taken towards a small CK-MB elevation in a patient with a low ejection fraction, versus a similar rise occurring in a patient with normal left ventricular function. Integrating the literature into the individual practice and to the specific patient remains the skill of the ‘true practitioner’. A. COLOMBO G. STANKOVIC Columbus Hospital and San Raffaele Hospital, Milan, Italy