Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

Only a small minority of the numerous patients who visit emergency departments (Eds) with chest pain (8–10 million per year in the USA) have acute myocardial infarction (MI) or another life-threatening disorder.1 However, failing to detect a serious condition can entail grave clinical sequelae and/or major liability. Thus, the dilemma of low risk but high stakes in this patient population continues to drive the search for innovative strategies to afford rapid identification of patients requiring admission and safe, early discharge in the large majority with a benign problem.

Approaches to this challenge have undergone continuous evolution over the past several decades. Historical ‘rule out MI’ procedures consuming days of testing have given way to contemporary accelerated diagnostic protocols (ADPs) that have reduced the evaluation to hours. ADPs are based on initial recognition of low risk reflected by clinical stability, normal electrocardiogram (ECG), and negative cardiac injury markers, usually followed by a predischarge cardiac test (PDT) to endorse suitability for early discharge.1–3 PDTs vary from exercise ECG to stress imaging or computed tomography coronary angiography (CTCA), depending on institutional resources, expertise and physician preference. Negative results allow discharge with outpatient follow-up while abnormal findings mandate admission. For more than two decades, this strategy has averted unnecessary admissions, reduced length of stay (LOS) and resulted in safe outcomes.1,3,4 ADPs have been associated with a greater than 99% negative predictive value for adverse cardiac events at 30 days or longer.1 However, despite these commendable results, the necessity of routine predischarge cardiac testing to conclude a negative evaluation convincingly in low-risk patients has been challenged on grounds of rationale, resource utilization, and cost.5–7

Issue Section:
Editorial
You do not currently have access to this article.
Download all slides

Comments

0 Comments
Comments (0)
Submit a comment
You have entered an invalid code
Thank you for submitting a comment on this article. Your comment will be reviewed and published at the journal's discretion. Please check for further notifications by email.