Triage, diagnosis and management of acute chest pain syndromes, atypical and high-risk subtypes of acute coronary artery syndromes

摘要

Patients presenting with chest pain suspected of an acute coronary syndrome represent a major challenge as inadvertent hospital discharge may have important consequences. The HEART score is a simple and effective tool to detect low risk patients who are eligible for early discharge. In a large retrospective study in this issue the HEART score performed equally good among Caucasian and different Asian ethnic groups. However, in contrast with earlier studies the negative predictive value was lower (95% instead of 99 to 100%) with a higher incidence of major adverse cardiac events indicating that further studies are needed to determine the safety of discharging low risk patients solely based on the HEART score. Performing a O & 1 hour serial sampling of a high sensitivity cardiac troponin along the calculation of the HEART score may possibly result in more accurate detection of a low risk group of chest pain patients that safely can be discharged from the emergency department.