Acute coronary syndromes: Initial evaluation and risk stratification

Raghunandan Kamineni, Joseph S. Alpert

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Chest pain, the second most frequent presenting complaint in the emergency department (ED), often poses a challenge to the physicians dealing with these patients owing to the wide spectrum of presentation of acute coronary syndromes (ACS). A majority of the patients presenting with chest pain are usually admitted to the hospital for further evaluation and management. Despite the availability of modern-day tools for diagnosis of acute myocardial infarction (AMI), about 5% of patients with AMI are missed in the ED with subsequent associated morbidity and mortality and legal consequences. Several centers have adapted critical pathways derived from American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients presenting with ACS. We now have some evidence suggesting adherence to the critical pathways derived from ACC/AHA guidelines will optimize the quality of patient care and probably result in better patient outcomes. This article reviews initial evaluation and the importance of risk stratification of the patients presenting with chest pain using the currently available clinical and diagnostic tools. Critical pathways derived from the ACC/AHA guidelines for various presentations of ACS are also reviewed.

Original languageEnglish (US)
Pages (from-to)379-392
Number of pages14
JournalProgress in Cardiovascular Diseases
Issue number5
StatePublished - 2004

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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