Chest pain emergency centers: Improving acute myocardial infarction care

Uncertainty and delay are common in the diagnosis of acute coronary syndrom es (ACS). In the last 20 years, the need for faster, more accurate, and mor e cost-effective diagnosis gave rise to the concept of specialized treatmen t of patients with chest pain in emergency departments (EDs). The original strategy dedicated a separate section of the ED and a nursing staff to the task of rapid intervention in patients with acute myocardial infarction (MI ) and triage of low-risk patients. Chest pain centers grew quickly in popul arity but evolved with a variety of goals, staffing plans, diagnostic resou rces, and levels of commitment. Three existing centers-the University of Ci ncinnati Heart ER, Brigham and Women's Hospital, and the Medical College of Virginia-have implemented chest pain strategies with the common aims of (I ) screening for the entire spectrum of coronary artery disease, (2) avoidin g unnecessary admissions, and (3) using multiple diagnostic modalities. Yet , they differ in the specifics of their approaches and diagnostic methods ( e.g., echocardiography vs. treadmill vs, myocardial perfusion imaging). The safety and cost effectiveness of these centers are discussed.