Testing of Low-Risk Patients Presenting to the Emergency Department With Chest Pain

By E. Amsterdam, J. Kirk, David A. Bluemke, D. Diercks, M. Farkouh, J. Garvey, M. Kontos, J. McCord, T. Miller, A. Morise and 4 more. Circulation, 2010

598 citations recorded by the source corpus.

The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective. Clinical judgment and basic clinical tools (history, physical examination, and electrocardiogram) remain primary in meeting this challenge and affording early identification of low-risk patients with chest pain. Additionally, established and newer diagnostic methods have extended clinicians' diagnostic capacity in this setting. Low-risk patients presenting with chest pain are increasingly managed in chest pain units in which accelerated diagnostic protocols are performed, comprising serial electrocardiograms and cardiac injury markers to exclude acute coronary syndrome. Patients with negative findings usually complete the accelerated diagnostic protocol with a confirmatory test to exclude ischemia. This is typically an exercise treadmill test or a cardiac imaging study if the exercise treadmill test is not applicable. Rest myocardial perfusion imaging has assumed an important role in this setting. Computed tomography coronary angiography has also shown promise in this setting. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain.

Subfields: Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/f07c6feab9fee11defe5ab9ed15a34dc214c755f

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Cardiology and Cardiovascular Medicine

Citations in the corpus

Third universal definition of myocardial infarction. (2012, background): “Normal function and viability have a very high negative predictive value and practically exclude acute MI (63).”
Fourth Universal Definition of Myocardial Infarction (2018). (2018, unknown): “Normal function practically excludes significant MI, but a small MI cannot be ruled out.(194) Thus, imaging techniques are useful for early triage and discharge of patients with suspected MI.”
Fourth universal definition of myocardial infarction (2018). (2019, unknown): “Normal function practically excludes significant MI, but a small MI cannot be ruled out.(194) Thus, imaging techniques are useful for early triage and discharge of patients with suspected MI.”