Admission for coronary syndrome – pro
Millman considers a one day admission appropriate for acute coronary syndrome. This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia. Patients with unstable angina, ECG changes, or both should be admitted to a telemetry bed. A certain subset of patients with stable angina may be treated as outpatients with antianginal agents, but close follow-up is necessary. Patients with chronic stable angina may be considered for discharge from the ER after occurrence of the following:
◦Symptom duration is brief and identical to symptoms experienced in the past.
◦ECG is normal or unchanged.
◦Patient has access to timely follow-up with a primary care provider.
•When in doubt, admit. The usual reason for a patient with chronic stable angina to present to the ED is a change in pattern or severity of symptoms, which makes their angina unstable.
The necessasry length of stay is determined by response to therapy. In many cases, next day discharge is possible; in others, thrombolysis or percutaneous intervention may be considered.
Millman, Chest Pain, Angina/Acute Coronary Syndrome
Ryan RJ, Lindsell CJ, Hollander JE, O’Neil B, Jackson R, Schreiber D, et al. A multicenter randomized controlled trial comparing central laboratory and point-of-care cardiac marker testing strategies: the Disposition Impacted by Serial Point of Care Markers in Acute Coronary Syndromes (DISPO-ACS) trial. Ann Emerg Med. Mar 2009;53(3):321-8. [Medline].
Fesmire FM, Decker WW, Diercks DB, Ghaemmaghami CA, Nazarian D, Brady WJ, et al. Clinical policy: critical issues in the evaluation and management of adult patients with non-ST-segment elevation acute coronary syndromes. Ann Emerg Med. Sep 2006;48(3):270-301. [Medline].
Harrington RA, Becker RC, Cannon CP, Gutterman D, Lincoff AM, Popma JJ, et al. Antithrombotic therapy for non-ST-segment elevation acute coronary syndromes: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. Jun 2008;133(6 Suppl):670S-707S. [Medline].
Storrow AB, Apple FS, Wu AH, Jesse R, Francis G, Christenson RH. Use of cardiac biomarkers for acute coronary syndromes. In: Laboratory medicine practice guidelines: evidence-based practice for point-of-care testing. Washington (DC): National Academy of Clinical Biochemistry (NACB). 2006;13-20.