Excerpt

Between 6 and 10 million patients are brought to US emergency departments with chest pain annually, accounting for 5 to 10% of all ED visits.1,2 A subset of these patients will have acute coronary syndrome (ACS) including an acute myocardial infarction (MI). Missing an acute MI is a significant risk of morbidity for patients and risk of litigation for emergency physicians. While a historical miss rate of 2% to 4% is commonly quoted, more recent data suggest that current diagnostic strategies reduce this miss rate below 1%.3-5 While this reduction in missed MIs is desirable, it comes at the cost of increased rates of hospital admissions for chest pain “rule outs” and additional diagnostic tests, accruing more than $3 billion in annual hospital costs in the US and subjecting many patients to testing that may not be necessary.6,7 …