Filippo Ottani, Nicola Binetti, Casagranda Ivo, Cassin Matteo, Cavazza Mario, Grifoni Stefano, Lenzi Tiziano, Lorenzoni Roberto, Sbrojavacca Rodolfo, Tanzi Pietro, Vergara Giuseppe
U.O. di Cardiologia, Ospedale Morgagni-Pierantoni, Via Forlanini, 34 47100 Forli.
G Ital Cardiol (Rome). 2009 Jan;10(1):46-63.
The evaluation of acute chest pain remains challenging, despite many insights and innovations over the past two decades. The percentage of patients presenting at the emergency department with acute chest pain who are subsequently admitted to the hospital appears to be increasing. Patients with acute coronary syndromes who are inadvertently discharged from the emergency department have an adverse short-term prognosis. However, the admission of a patient with chest pain who is at low risk for acute coronary syndrome can lead to unnecessary tests and procedures, with their burden of costs and complications. Therefore, with increasing economic pressures on health care, physicians and administrators are interested in improving the efficiency of care for patients with acute chest pain. Since the emergency department organization (i.e. the availability of an intensive observational area) and integration of care and treatment between emergency physicians and cardiologists greatly differ over the national territory, the purpose of the present position paper is two-fold: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the basic critical pathways (describing key steps for care and treatment) that need to be implemented in order to standardize and expedite the evaluation of chest pain patients, making their diagnosis and treatment as uniform as possible across the country.
尽管在过去二十年中有许多见解和创新，但急性胸痛的评估仍然具有挑战性。因急性胸痛到急诊科就诊、随后被收住院的患者比例似乎在上升。从急诊科意外出院的急性冠状动脉综合征患者有不良的短期预后。然而，低风险急性冠状动脉综合征胸痛患者的住院可能导致不必要的检查和程序，带来成本和并发症负担。因此，在医疗保健面临日益增加的经济压力的情况下，医生和管理人员有兴趣提高急性胸痛患者的护理效率。由于全国各地急诊科的组织情况（即强化观察区域的可用性）以及急诊医生和心脏病专家之间的护理和治疗整合情况差异很大，本立场文件的目的有两个：第一，回顾各种诊断工具基于证据的疗效和效用；第二，描绘为规范和加快胸痛患者评估需要实施的基本关键路径（描述护理和治疗的关键步骤），使全国范围内的诊断和治疗尽可能统一。
