REVIEW

New methods for improved evaluation of patients with suspected acute coronary syndrome in the emergency department

U Ekelund, J L Forberg

Division of Emergency Medicine, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden

Correspondence to:
Professor U Ekelund, Division of Emergency Medicine, Lund University Hospital, SE-221 85 Lund, Sweden; ulf.ekelund{at}med.lu.se

This paper aims to identify and review new and unproven emergency department (ED) methods for improved evaluation in cases of suspected acute coronary syndrome (ACS). Systematic news coverage through PubMed from 2000 to 2006 identified papers on new methods for ED assessment of patients with suspected ACS. Articles found described decision support models, new ECG methods, new biomarkers and point-of-care testing, cardiac imaging, immediate exercise tests and the chest pain unit concept. None of these new methods is likely to be the perfect solution, and the best strategy today is therefore a combination of modern methods, where the optimal protocol depends on local resources and expertise. With a suitable combination of new methods, it is likely that more patients can be managed as outpatients, that length of stay can be shortened for those admitted, and that some patients with ACS can get earlier treatment.

Abbreviations: AMI, acute myocardial infarction; ACS, acute coronary syndrome; BNP, B-type natriuretic peptide; CPU, chest pain unit; CRP, C reactive protein; ECG, electrocardiogram; ED, emergency department; MDCT, multidetector computed tomography; MPI, myocardial perfusion imaging; MRI, magnetic resonance imaging

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