Assessment of Patients with Chest Pain
Authors: Lee Goldman, Ajay J. Kirtane
Journal: Annals of Internal Medicine (2004)

Letters17 August 2004Assessment of Patients with Chest PainLee Goldman, MD and Ajay J. Kirtane, MDLee Goldman, MDFrom University of California, San Francisco, San Francisco, CA 94143-0120; and Beth Israel Deaconess Medical Center, Boston, MA 02215.Search for more papers by this author and Ajay J. Kirtane, MDFrom University of California, San Francisco, San Francisco, CA 94143-0120; and Beth Israel Deaconess Medical Center, Boston, MA 02215.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-4-200408170-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the comments of Drs. Reilly and Evans and agree that decisions must be based on the potential benefits of subsequent interventions rather than on diagnosis alone. However, accurate diagnosis often must precede appropriate therapy. For acute chest pain, the initial triage should provide urgent therapies of known benefit: recanalization with primary angioplasty or thrombolysis for ST-segment elevation acute MI and interventions to prevent infarction or limit its size in patients with non–ST-segment elevation acute coronary syndromes. An accurate reading of the initial electrocardiogram is critical to guide these interventions and to determine the most appropriate setting ...References1. Heeschen C, Dimmeler S, Hamm CW, van den Brand MJ, Boersma E, Zeiher AM, et al . Soluble CD40 ligand in acute coronary syndromes. N Engl J Med. 2003;348:1104-11. [PMID: 12646667] CrossrefMedlineGoogle Scholar2. Brennan ML, Penn MS, Van Lente F, Nambi V, Shishehbor MH, Aviles RJ, et al . Prognostic value of myeloperoxidase in patients with chest pain. N Engl J Med. 2003;349:1595-604. [PMID: 14573731] CrossrefMedlineGoogle Scholar3. Goldman L, Cook EF, Johnson PA, Brand DA, Rouan GW, Lee TH. Prediction of the need for intensive care in patients who come to the emergency departments with acute chest pain. N Engl J Med. 1996;334:1498-504. [PMID: 8618604] CrossrefMedlineGoogle Scholar4. Reilly BM, Evans AT, Schaider JJ, Das K, Calvin JE, Moran LA, et al . Impact of a clinical decision rule on hospital triage of patients with suspected acute cardiac ischemia in the emergency department. JAMA. 2002;288:342-50. [PMID: 12117399] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, CA 94143-0120; and Beth Israel Deaconess Medical Center, Boston, MA 02215. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTriage of Patients with Acute Chest Pain and Possible Cardiac Ischemia: The Elusive Search for Diagnostic Perfection Lee Goldman and Ajay J. Kirtane Assessment of Patients with Chest Pain Brendan M. Reilly and Arthur T. Evans Assessment of Patients with Chest Pain Stephen Workman Assessment of Patients with Chest Pain James R. Johnson Metrics 17 August 2004Volume 141, Issue 4Page: 326KeywordsAcute coronary syndromeAngioplastyElectrocardiographyEmergency departmentInfarctionIschemiaOutpatientsRisk assessmentsTriage ePublished: 17 August 2004 Issue Published: 17 August 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...