A RAPID DIAGNOSTIC AND TREATMENT CENTER FOR PATIENTS WITH CHEST PAIN IN THE EMERGENCY DEPARTMENT

Study objective: To evaluate a comprehensive diagnostic 9-hour evaluat ion (Heart ER Program) for patients with possible acute ischemic coron ary syndromes. Design: Retrospective review of consecutive patients. S etting: Urban tertiary care emergency department. Participants: A tota l of 1,010 patients with symptoms suggestive of acute ischemic coronar y syndrome was enrolled in the Heart ER Program over the first 32 mont hs of operation. Patients with history of coronary artery disease, hem odynamic instability, acute ST-segment elevation or depression of more than 1 mm, or a clinical syndrome consistent with unstable agina were directly admitted to the hospital. Intervention: Patients underwent s erial testing for creatine kinase (CK-MB) on presentation to the Heart ER and 3, 6, and 9 hours later with continuous 12-lead ECGs/serial ST -segment trend monitoring for 9 hours. Two-dimensional echocardiograph y and graded exercise testing were performed in the ED after the 9-hou r evaluation period. Results: Of 1,010 patients, 829 (82.1%) were rele ased home from the ED; 153 (15.1%) required admission for further card iac evaluation. Fifty-two of 153 (33.9%) admitted patients were found to have a cardiac cause for their symptoms; 43 had acute ischemic coro nary syndromes (12, acute myocardial infarction; 31, angina or unstabl e angina). Conclusion: The Heart ER program provides an effective meth od for evaluating low- to moderate-risk patients with possible acute i schemic coronary syndrome in the ED setting.