• Neil Goyal, Jennifer Stant, Francesca Esposito, Gina Piri, Michael Collins, Osman Sayan, Gerald Neuberg, Leslie Miller, Jeffery W Moses, Gregg W Stone, James Giglio, and LeRoy E Rabbani.
• Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY 10032, USA.
• Crit Pathw Cardiol. 2008 Dec 1;7(4):211-22.

AbstractIn 2003, we published our chest pain protocol for the management of acute coronary syndromes (ACSs) and acute myocardial infarction. Our algorithm was specifically designed for our institution, which was primary percutaneous coronary intervention (PCI) for all ST-elevation myocardial infarctions (STEMIs) and a preferred invasive approach for non-STEMIs. Since 2003, there have been numerous changes in the adjunctive pharmacotherapeutic armamentarium for PCI in both the STEMI and non-STEMI ACS context. We present our updated chest pain algorithm with a brief review of the rapidly evolving changes in adjunctive pharmacotherapy for PCI and provide a rationale for the changes that we have made to our institutional protocol. Clinical pathways need to be consistently updated and revises by incorporating new evidence from clinical trials in order to maintain clinical relevance.

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