Purpose of the Review

To review the initial evaluation of chest pain in the emergency department (ED), with a focus on coronary artery disease (CAD) and acute coronary syndromes (ACS), using consensus statements from major cardiovascular disease organizations.

Recent findings

Major cardiovascular organizations have released consensus statements on this topic, notably the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain and the 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department. Also, recent studies have evaluated the use of high sensitivity troponin (hs-cTn) to safely rule out myocardial infarction (MI), with the development of rule-out pathways designed to be utilized in the ED.

Summary

This review highlights the comprehensive differential diagnoses of chest pain in the ED and urgent management of these etiologies, with a focus on cardiovascular etiologies. There exist a few rule-out pathways recommended by major cardiovascular organizations, notably the high-STEACS and the ESC 0/1 and 0/2 pathways that can safely and quickly discharge patients with low risk of MI.

中文翻译：

---

急诊科急性胸痛患者的初步评估和处理

审查的目的

使用主要心血管疾病组织的共识声明，回顾急诊科 (ED) 胸痛的初步评估，重点关注冠状动脉疾病 (CAD) 和急性冠状动脉综合征 (ACS)。

最近的发现

主要心血管组织已就此主题发布了共识声明，特别是 2021 年 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR 胸痛评估和诊断指南和 2022 年 ACC 关于胸痛评估和处置的专家共识决策路径急诊室出现急性胸痛。此外，最近的研究还评估了使用高敏肌钙蛋白 (hs-cTn) 安全排除心肌梗死 (MI) 的方法，并开发了专门用于 ED 的排除途径。

概括

这篇综述强调了急诊室胸痛的综合鉴别诊断和这些病因的紧急处理，重点是心血管病因。主要心血管组织推荐了一些排除途径，特别是高 STEACS 以及 ESC 0/1 和 0/2 途径，可以安全、快速地让低 MI 风险的患者出院。