• Pablo Castro, Ramón Corbalán, Rodrigo Isa, Luigi Gabrielli, Osvaldo Pérez, Gastón Chamorro, Bernardita Garayar, Ricardo Baeza, Ismael Vergara, Iván Godoy, Mónica Acevedo, Alejandro Fajuri, Marcelo Fernández, José Miguel Mardones, Alex Bittner, and José Antonio Rodríguez.
• Departamento de Enfermedades Cardiovasculares, Hospital Clínico y Facultad de Medicina, Pontifica Universidad Católica de Chile, Chile. pcastro@med.puc.cl.
• Rev Med Chil. 2007 Jul 1;135(7):839-45.

BackgroundIn large series, nearly 60% of admissions for suspected acute coronary syndrome (ACS) had a non-coronary etiology of the pain. However, short term mortality of non recognized ACS patients, mistakenly discharged from the emergency room is at least twice greater than the expected if they would had been admitted. The concept of a chest pain unit (CPU) is a methodological approach developed to address these issues.AimTo evaluate the efficacy of a CPU in the emergency room of a general hospital for evaluation of acute chest pain.Material And MethodsProspective study of patients with chest pain admitted in the CPU. After a clinical, electrocardiographic and laboratory evaluation with cardiac injury serum markers, patients were stratified in three risk groups, based on the likelihood of ACS of the American Heart Association. High probability patients were admitted to the Coronary Unit (CU) for treatment. Moderate probability patients remained in the CPU for further evaluation and low probability patients were discharged with telephonic follow-up.ResultsOf 407 patients, 35, 30 and 35% were stratified as high, intermediate and low probability ACS, respectively. Among patients admitted with high probability, 73% had a confirmed ACS diagnosis. Among intermediate probability patients, 86% were discharged after an evaluation in the CPU without adverse events in the follow-up.ConclusionStructured risk evaluation approach in a CPU improves the management of acute chest pain, identifying high probability patients for fast admission and start of treatment in a CU and allowing safe discharge of low probability ones.

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