title: Updating the chest pain algorithm: incorporating new evidence.
abstract: 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.
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Goyal
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stant
authors.forename: Francesca
authors.initials: F
authors.lastname: Esposito
authors.forename: Gina
authors.initials: G
authors.lastname: Piri
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Osman
authors.initials: O
authors.lastname: Sayan
authors.forename: Gerald
authors.initials: G
authors.lastname: Neuberg
authors.forename: Leslie
authors.initials: L
authors.lastname: Miller
authors.forename: Jeffery W
authors.initials: JW
authors.lastname: Moses
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: James
authors.initials: J
authors.lastname: Giglio
authors.forename: LeRoy E
authors.initials: LE
authors.lastname: Rabbani
mesh_terms: 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