Lee Goldman, MD; Ajay J. Kirtane, MD
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Goldman L., Kirtane A.; Assessment of Patients with Chest Pain. Ann Intern Med. 2004;141:326. doi: 10.7326/0003-4819-141-4-200408170-00026
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Published: Ann Intern Med. 2004;141(4):326.
We appreciate the comments of Drs. Reilly and Evans and agree that decisions must be based on the potential benefits of subsequent interventions rather than on diagnosis alone. However, accurate diagnosis often must precede appropriate therapy. For acute chest pain, the initial triage should provide urgent therapies of known benefit: recanalization with primary angioplasty or thrombolysis for ST-segment elevation acute MI and interventions to prevent infarction or limit its size in patients with non–ST-segment elevation acute coronary syndromes. An accurate reading of the initial electrocardiogram is critical to guide these interventions and to determine the most appropriate setting for observation and rapid treatment if complications occur. The “ruling out” of MI certainly is not the sole quality benchmark but is linked to management strategies proven to improve outcomes. If a patient is mistakenly discharged, the opportunity to provide these benefits is delayed or lost.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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