Approach to the ED Patient with "Low-Risk" Chest Pain

Emergency Medicine Clinics of North America

Volumn 29, Issue 4, 2011, Pages 721-727

  Kosowsky, Joshua M ^a  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

Author keywords

Chest pain; Emergency department; Low risk

Indexed keywords

BIOLOGICAL MARKER; CREATINE KINASE MB;

ACUTE CORONARY SYNDROME; ANGIOCARDIOGRAPHY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CORONARY ARTERY DISEASE; CORONARY RISK; DEMOGRAPHY; ECG ABNORMALITY; EMERGENCY WARD; EVIDENCE BASED EMERGENCY MEDICINE; HOSPITAL DISCHARGE; HUMAN; IMAGE QUALITY; MEDICAL HISTORY; MYOCARDIAL PERFUSION IMAGING; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROTEIN ANALYSIS; REVIEW; RISK ASSESSMENT; SENSITIVITY AND SPECIFICITY; SINGLE PHOTON EMISSION COMPUTER TOMOGRAPHY; ST SEGMENT ELEVATION MYOCARDIAL INFARCTION; STRESS ECHOCARDIOGRAPHY; THORAX PAIN; TREADMILL EXERCISE;

EID: 80055062969     PISSN: 07338627     EISSN: 07338627     Source Type: Journal    
DOI: 10.1016/j.emc.2011.09.017     Document Type: Review

References (35)

1. Bhuiya F.A., Pittts S.R., McCaig L.F. Emergency department visits for chest pain and abdominal pain: United States, 1999-2008. NCHS Data Brief 2010, 16(43):1-8. Centers for Disease Control and Prevention.
2. Pope J.H., Aufderheide T.P., Ruthazer R., et al. Missed diagnosis of acute cardiac ischemia in the emergency department. N Engl J Med 2000, 342:1163-1170.
3. Mehta R.H., Eagle K.A. Missed diagnosis of acute coronary syndrome in the emergency room-continuing challenges. N Engl J Med 2000, 342(16):1207-1209.
4. Gordon T., Sorlie P., Kannel W. Coronary heart disease, atherothrombotic brain infarction, intermittent claudication-a multivariate analysis of some factors related to their incidence: Framingham Study, 16 years follow up 1971, US Government Printing Office, Washington, DC.
5. Truett J., Cornfield J., Kanell W. A multivariate analysis of the risk of coronary artery disease in Framingham. J Chronic Dis 1967, 20:511-524.
6. Jayes R.L., Beshansky J.R., D'Agostino R.B., et al. Do patients' coronary risk factor reports predict acute cardiac ischemia in the emergency department? A multicenter study. J Clin Epidemiol 1992, 45(6):621-626.
7. Sievers J. Clinical features and outcome in three thousand thirty-six cases. Acta Med Scand 1964, 406(Suppl):1-12.
8. Leven D. Chest pain-prophet of doom or nagging necrosis?. Acta Med Scand 1981, 644(Suppl):11-13.
9. Short D. Diagnosis of slight and subacute coronary attacks in the community. Br Heart J 1981, 45:299-310.
10. Lee T., Cook E., Weisberg M., et al. Acute chest pain in the emergency room: identification and examination of low-risk patients. Arch Intern Med 1985, 145:65-69.
11. Wilkinson K., Severance H. Identification of chest pain patients appropriate for an emergency department observation unit. Emerg Med Clin North Am 2001, 19(1):35-66.
12. Swap C.J., Nagurney J.T. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndrome. JAMA 2005, 294(20):2623-2629.
13. Fesmire F.M., Wardton D.R., Calhoun F.B. Instability of ST segment sin the early stages of acute myocardial infarction in patients undergoing continuous 12-lead ECG monitoring. Am J Emerg Med 1995, 13:158-163.
14. Fesmire F.M., Bardoner J.B. ST-segment instability preceding simultaneous cardiac arrest and AMI in a patient undergoing continuous 12-lead ECG monitoring. Am J Emerg Med 1994, 12:69-76.
15. Fesmire F.M., Percy R.F., Wears R.L., et al. Initial ECG in Qwave and non-Qwave myocardial infarction. Ann Emerg Med 1989, 18:741-746.
16. Fesmire F.M., Decker W.W., Diercks D.B., et al. Clinical policy: critical issue in the evaluation and management of adult patients with non-ST-segment elevation acute coronary syndromes. Ann Emerg Med 2006, 48(3):272.
17. Kontos M.C., Anderson F.P., Schmidt K.A., et al. Early diagnosis of acute myocardial infarction in patients without ST-segment elevation. Am J Cardiol 1999, 83:155-158.
18. Apple F.S., Anderson F.P., Collinson P., et al. Clinical evaluation of the first medical whole blood, point-of-care testing device for detection of myocardial infarction. Clin Chem 2000, 46:1604-1609.
19. Gibler W.B., Hoekstra J.W., Weaver W.D., et al. A randomized trial of the effects of early cardiac serum marker availability on reperfusion therapy in patients with acute myocardial infarction: the serial markers, acute myocardial infarction and rapid treatment trial (SMARTT). J Am Coll Cardiol 2000, 36:1500-1506.
20. Fesmire F.M., Christenson R.H., Fody E.P., et al. Delta creatine kinase-MB outperforms myoglobin at two hours during the emergency department identification and exclusion of troponin positive non-ST-elevation acute coronary syndromes. Ann Emerg Med 2004, 44:12-19.
21. Reichlin T., Hochholzer W., Bassetti S., et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009, 361:858-867.
22. Yiadom M.Y., Kosowsky J.M., Melanson S.L., et al. Diagnostic performance of a highly sensitive cardiac troponin I assay in an emergency department setting. Clin Chem 2010, 56(Suppl 6):A131.
23. Alcalai R., Planer D., Culhaoglu A., et al. Acute coronary syndrome vs nonspecific troponin elevation: clinical predictors and survival analysis. Arch Intern Med 2007, 167:276-281.
24. Daly S., Campbell D.A., Cameron P.A. Short-stay units and observation medicine: a systematic review. Med J Aust 2003, 178:559-563.
25. Martinez E., Reilly B.M., Evans A.T., et al. The observation unit: a new interface between inpatient and outpatient care. Am J Med 2001, 110:274-277.
26. Anderson J.L., Adams C.D., Antman E.M., et al. American College of Cardiology/American Heart Association 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2007, 50:e1-e157.
27. Chan G.W., Sites F.D., Shofer F.S., et al. Impact of stress testing on 30-day cardiovascular outcomes for low-risk patients with chest pain admitted to floor telemetry beds. Am J Emerg Med 2003, 21:282-287.
28. Mikhail M.G., Smith F.A., Gray M., et al. Cost-effectiveness of mandatory stress testing in chest pain center patients. Ann Emerg Med 1997, 29:88-98.
29. Mair J., Smidt J., Lechleitner P., et al. A decision tree for the early diagnosis of acute myocardial infarction in nontraumatic chest pain patients at hospital admission. Chest 1995, 108:1502-1509.
30. Hilton T.C., Thompson R.C., Williams H.J., et al. Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. J Am Coll Cardiol 1994, 23:1016-1022.
31. Varetto T., Cantalupi D., Altieri A., et al. Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms. J Am Coll Cardiol 1993, 22:1804-1808.
32. Amsterdam E.A., Kirk J.D., Diercks D.B., et al. Exercise testing in chest pain units: rational, implementation, and results. Cardiol Clin 2005, 23:503-516.
33. Fleischmann K.E., Hunink M.G., Kuntz K.M., et al. Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. JAMA 1998, 280:913.
34. Gianrossi R., Detrano R., Mulvhill D., et al. Exercise-induced ST depression in the diagnosis of coronary artery disease: a meta-analysis. Circulation 1989, 80:87.
35. Hoffman U., Ferencik M., Cury R., et al. Coronary CT angiography. J Nucl Med 2006, 47:797-806.