title: State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes.
abstract: It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia. The improvement in cardiac troponin assays, especially in conjunction with well-validated clinical decision algorithms, now enables the clinician to rapidly exclude myocardial infarction. In patients in whom unstable angina remains a concern or there is a desire to evaluate for underlying coronary artery disease, coronary computed tomography angiography can be used in the emergency department. Once a process that took ≥24 hours, computed tomography angiography now can rapidly exclude myocardial infarction and coronary artery disease in patients in the emergency department.
authors.affiliation: From Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (J.E.H.); Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand (M.T.); and Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (C.M.).
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: From Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (J.E.H.); Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand (M.T.); and Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (C.M.).
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.affiliation: From Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (J.E.H.); Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand (M.T.); and Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (C.M.).
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods / Q000592:standards; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards
keywords: acute coronary syndrome; chest pain; coronary computerized tomographic angiography; emergency service, hospital; risk assessment; troponin