Advances create opportunities: Implementing the major tenets of the new unstable angina guidelines in the emergency department

Of all the clinical syndromes with which emergency physicians must deal, ch est pain of coronary cause has benefited from the most striking recent adva nces both in diagnostic approach (cognitive and technologic) and in therape utic options. Chest pain evaluation and management have become important fo ci of research in emergency medicine, and entire units are dedicated to its clinical prosecution in emergency departments and elsewhere in the hospita l. New diagnostic tools are proposed and studied on a regular basis. Antipl atelet, antithrombin, and fibrinolytic agents unknown in clinical practice as recently as 5 years ago have secured places in the emergency physician's armamentarium for treating acute coronary syndrome. Many of these diagnost ic and therapeutic tools have been developed in the coronary care unit and in the cardiac catheterization laboratory. Although intuitively they may al so be useful outside of those settings, they have unreliably been brought t o the ED for implementation and resultant appropriate prompt and early care of the coronary patient who does not meet fibrinolytic criteria. As emerge ncy physicians seek to bring accurate chest pain risk stratification into t heir practice and begin to use new therapeutic agents to minimize myocardia l damage before turning the patient's care over to other specialists, it is essential that they are familiar with the data supporting these approaches . In this commentary, we seek to place the American College of Cardiology/A merican Heart Association unstable angina guidelines into the clinical cont ext of the ED.