[Chest pain and acute myocardial infarction at the emergency department: diagnostic and therapeutic approaches. Experience of the San Camillo Hospital in Rome].
BACKGROUND
Identification and treatment of patients with acute chest pain due to acute coronary syndrome is a common and difficult challenge for emergency physicians. The aim of this study was to establish: a) the reliability of diagnosis of acute myocardial infarction met in the emergency ward, b) the length of the patient's hospital stay with acute myocardial infarction discovered and treated in the emergency ward either with primary angioplasty or with thrombolysis.


METHODS
We analyzed the data collected in the emergency ward of the San Camillo Hospital in Rome from January 1 to June 30, 2000, with patients suffering from chest pain and diagnosis after hospitalization. The reliability of diagnosis of acute myocardial infarction was calculated from the comparison of the diagnosis in the emergency ward and the diagnosis at hospital discharge.


RESULTS
From January 1 to June 30, 2000, 45,810 patients have asked for help at the emergency ward; 2334 (5.1%) of these were suffering from chest pain. The diagnosis of acute myocardial infarction was done in the emergency ward in 147 cases (141 hospitalized, 4 deceased, and 2 transferred to other hospitals), equal to 65% of all those discharged with the same diagnosis in the period under examination. In 66 out of the 141 cases hospitalized (46.8%) primary angioplasty was successfully performed; in 14 (9.9%) only coronary angiography was performed (primary angioplasty unfeasible); in 22 (15.6%) thrombolysis was administered whereas in 38 cases (27.0%) other treatments were used. The average stay for the different groups turned out to be 9.8 +/- 4 days for primary angioplasty and 12.9 +/- 4 days for thrombolysis: the difference was relevant.


CONCLUSIONS
The accuracy value of the diagnosis of acute myocardial infarction made in the emergency ward of our Hospital is the same as that published in the international literature and demonstrates the high level of treatment of chest pain. Furthermore, the shorter hospital stay obtained by primary angioplasty in comparison with thrombolysis seems to strengthen the already favorable cost-benefit ratio of primary angioplasty in comparison with thrombolysis.
Salvini
P
P
Dipartimento di Emergenza-Accettazione, Azienda Ospedaliera San Camillo-Forlanini, Roma.
Parma
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D004630:Emergencies; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D015203:Reproducibility of Results; D012384:Rome