Updating the chest pain algorithm: incorporating new evidence.
In 2003, we published our chest pain protocol for the management of acute coronary syndromes (ACSs) and acute myocardial infarction. Our algorithm was specifically designed for our institution, which was primary percutaneous coronary intervention (PCI) for all ST-elevation myocardial infarctions (STEMIs) and a preferred invasive approach for non-STEMIs. Since 2003, there have been numerous changes in the adjunctive pharmacotherapeutic armamentarium for PCI in both the STEMI and non-STEMI ACS context. We present our updated chest pain algorithm with a brief review of the rapidly evolving changes in adjunctive pharmacotherapy for PCI and provide a rationale for the changes that we have made to our institutional protocol. Clinical pathways need to be consistently updated and revises by incorporating new evidence from clinical trials in order to maintain clinical relevance.
Goyal
Neil
N
Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY 10032, USA.
Stant
Jennifer
J
Esposito
Francesca
F
Piri
Gina
G
Collins
Michael
M
Sayan
Osman
O
Neuberg
Gerald
G
Miller
Leslie
L
Moses
Jeffery W
JW
Stone
Gregg W
GW
Giglio
James
J
Rabbani
LeRoy E
LE
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000465:Algorithms; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002637:Chest Pain / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D019091:Critical Pathways / Q000592:standards / Q000639:trends*; D019317:Evidence-Based Medicine; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States