Optimal Identification of the Patient with Acute Myocardial Ischemia in the Emergency Room

Abstract

Although angina pectoris was meticulously described more than 200 years ago by Heberden [1] and the presentation of myocardial infarction was first reported 50 years ago by Herrick [2], accurate identification of acute ischemic heart disease (AIHD) in the emergency room (ER) remains a task that challenges the skill of the most seasoned clinician. In the United States, for each coronary care unit (CCU) patient in whom AIHD is confirmed, two patients are admitted with this as an ER diagnosis. There are great costs to patients and to the medical reimbursement system resulting from the large number of false-positive AIHD diagnoses and the resulting CCU overuse. Since each year in this country more than 1.5 million patients with suspected AIHD are admitted to CCUs, even a modest improvement in admitting practices would yield substantial savings. Additionally, many patients would be spared the needless physical and psychological side effects resulting from unnecessary admission to intensive care units. This chapter reviews studies that have attempted to optimize AIHD diagnostic accuracy in the ER setting.