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When Chest Pain Requires Quick Action in ER
Date:5/20/2009

For one, it helps settle a debate about whether early intervention might be harmful in some cases. "The study showed that early intervention does not increase the risk," Mehta said.

And then the findings can be applied to the not uncommon scenario when emergency department doctors have to deal with acute coronary syndrome at an awkward time or place -- late on Friday in a busy city hospital, for example.

"If you show up at 10 in the morning on Tuesday, you can have an angiography [which shows the extent of heart damage] by Tuesday afternoon," Mehta said. "If it is 10 p.m. on Friday, the vast majority of U.S. hospitals will not have an angiogram until Monday."

A judgment about whether quick treatment is needed can be made without much delay, said Dr. Richard A. Lange, vice chair of medicine at The University of Texas Health Science Center in San Antonio, and co-author of an editorial accompanying the study. "Most of the information can be gathered quickly, certainly by the time a patient is admitted to the intensive care unit," Lange said.

The issues with acute coronary syndrome start with "how intensive medical [drug] therapy should be," Lange said. "Then there is the question of whether the patient should go to the cath lab at all, or urgently. Those individuals who don't have many of the risk factors can receive less intensive treatment."

"Cath lab" is medical jargon for the hospital unit that does a coronary assessment by threading the thin tube called a catheter into a heart artery.

When the indicators show that someone is not at high risk, "you give intensive medical treatment and then go to the cath lab," Lange said. "For those at highest risk, you go right to the cath lab."

"The study showed that the majority of patients are not high risk," Mehta said. "They can go for angiography early or later."

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