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New categorization of chest pain: noncardiac is in, atypical is out!

Neue Einordnung des Thoraxschmerzes: Nichtkardial ist in, atypisch ist out!

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Abstract

Chest pain poses a diagnostic challenge in the emergency department and requires a thorough clinical assessment. The traditional distinction between “atypical” and “typical” chest pain carries the risk of not addressing nonischemic clinical pictures. The newly conceived subdivision into cardiac, possibly cardiac, and (probably) noncardiac causes of the presenting symptom complex addresses a much more interdisciplinary approach to a symptom-oriented diagnostic algorithm. The diagnostic structures of the chest pain units in Germany do not currently reflect this. An adaptation should therefore be considered.

Zusammenfassung

Thoraxschmerzen stellen in der Notaufnahme eine diagnostische Herausforderung dar und erfordern eine gründliche klinische Beurteilung. Die tradierte Unterscheidung von „atypischen“ und „typischen“ Brustschmerzen bergen die Gefahr, auf nichtischämische Krankheitsbilder nicht einzugehen. Die neu gedachte Unterteilung in eine kardiale, möglicherweise kardiale und (wahrscheinlich) nichtkardiale Ursache des präsentierten Symptomkomplexes berücksichtigt einen stärker interdisziplinären Ansatz eines symptomorientierten Diagnosealgorithmus. Die diagnostischen Strukturen der chest pain units in Deutschland bilden dies derzeit noch nicht ab. Eine Anpassung sollte daher erwogen werden.

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References

  1. Byrne RA, Rossello X, Coughlan JJ et al (2023) 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J 44(38):3720–3826. https://doi.org/10.1093/eurheartj/ehad191

    Article  CAS  PubMed  Google Scholar 

  2. Gulati M, Levy PD, Mukherjee D et al (2021) 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 144(22):e368–e454. https://doi.org/10.1161/CIR.0000000000001029

    Article  PubMed  Google Scholar 

  3. Breuckmann F, Rassaf T, Hochadel M et al (2021) German chest pain unit registry: data review after the first decade of certification. Herz 46(Suppl 1):24–32. https://doi.org/10.1007/s00059-020-04912-4

    Article  PubMed  Google Scholar 

  4. Giannitsis E, Post F, Haerer W et al (2020) Kriterien der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung für „Chest Pain Units“. Kardiologe 14(6):466–479. https://doi.org/10.1007/s12181-020-00417-w

    Article  Google Scholar 

  5. Amsterdam EA, Lewis WR, Kirk JD et al (2002) Acute ischemic syndromes. Chest pain center concept. Cardiol Clin 20(1):117–136. https://doi.org/10.1016/s0733-8651(03)00069-9

    Article  PubMed  Google Scholar 

  6. Furtado MV, Cardoso A, Patricio MC et al (2011) Influence of implementation of a chest pain unit on acute coronary syndrome outcomes. J Emerg Med 40(5):557–564. https://doi.org/10.1016/j.jemermed.2009.08.062

    Article  PubMed  Google Scholar 

  7. Gulati M, Levy PD, Mukherjee D et al (2021) 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. J Am Coll Cardiol 78(22):e187–e285. https://doi.org/10.1016/j.jacc.2021.07.053

    Article  PubMed  Google Scholar 

  8. Keller T, Post F, Tzikas S et al (2010) Improved outcome in acute coronary syndrome by establishing a chest pain unit. Clin Res Cardiol 99(3):149–155. https://doi.org/10.1007/s00392-009-0099-9

    Article  PubMed  Google Scholar 

  9. Munzel T, Heusch G (2017) Chest pain unit network in Germany: its effect on patients with acute coronary syndromes. J Am Coll Cardiol 69(19):2459–2460. https://doi.org/10.1016/j.jacc.2017.03.562

    Article  PubMed  Google Scholar 

  10. Varnavas V, Rassaf T, Breuckmann F (2018) Nationwide but still inhomogeneous distribution of certified chest pain units across Germany : need to strengthen rural regions. Herz 43(1):78–86. https://doi.org/10.1007/s00059-016-4527-0

    Article  CAS  PubMed  Google Scholar 

  11. Settelmeier S, Hochadel M, Giannitsis E et al (2021) Management of pulmonary embolism: results from the German chest pain unit registry. Cardiology 146(3):304–310. https://doi.org/10.1159/000513695

    Article  PubMed  Google Scholar 

  12. Imhof S, Hochadel M, Konstantinides S et al (2023) Cardiac, possible cardiac, and likely non-cardiac origin of chest pain : a hitherto underestimated parameter in German chest pain units. Herz. https://doi.org/10.1007/s00059-023-05230-1

    Article  PubMed  Google Scholar 

  13. Settelmeier S, Rassaf T, Hochadel M et al (2020) Gender differences in patients admitted to a certified German chest pain unit: results from the German chest pain unit registry. Cardiology 145(9):562–569. https://doi.org/10.1159/000509276

    Article  PubMed  Google Scholar 

  14. Collet JP, Thiele H, Barbato E et al (2021) 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 42(14):1289–1367. https://doi.org/10.1093/eurheartj/ehaa575

    Article  PubMed  Google Scholar 

  15. O’Gara PT, Kushner FG, Ascheim DD et al 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation 127(4):e362–e425. https://doi.org/10.1161/CIR.0b013e3182742cf6

  16. Anderson HV, Masri SC, Abdallah MS et al (2022) 2022 ACC/AHA key data elements and definitions for chest pain and acute myocardial infarction: a report of the American heart association/American college of cardiology joint committee on clinical data standards. J Am Coll Cardiol 80(17):1660–1700. https://doi.org/10.1016/j.jacc.2022.05.012

    Article  PubMed  Google Scholar 

  17. Fanaroff AC, Rymer JA, Goldstein SA et al (2015) Does this patient with chest pain have acute coronary syndrome?: the rational clinical examination systematic review. JAMA 314(18):1955–1965. https://doi.org/10.1001/jama.2015.12735

    Article  CAS  PubMed  Google Scholar 

  18. Bösner S, Becker A, Haasenritter J et al (2009) Chest pain in primary care: epidemiology and pre-work-up probabilities. Eur J Gen Pract 15(3):141–146. https://doi.org/10.3109/13814780903329528

    Article  PubMed  Google Scholar 

  19. Hsia RY, Hale Z, Tabas JA (2016) A national study of the prevalence of life-threatening diagnoses in patients with chest pain. JAMA Intern Med 176(7):1029–1032. https://doi.org/10.1001/jamainternmed.2016.2498

    Article  PubMed  Google Scholar 

  20. van Oosterhout REM, de Boer AR, Maas AHEM et al (2020) Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. J Am Heart Assoc 9(9):e014733. https://doi.org/10.1161/JAHA.119.014733

  21. Knuuti J, Wijns W, Saraste A et al (2020) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Herat J 41(3):407–477. https://doi.org/10.1093/eurheartj/ehz425

  22. Virani SS, Newby LK, Arnold SV et al (2023) 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 148(9):e9–e119. https://doi.org/10.1161/CIR.0000000000001168

  23. Gesundheit Bd (2024) Bundesgesundheitsminister Lauterbach legt Eckpunkte zur Notfallreform vor https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/eckpunkte-notfallverorgung-pm-16-01-24. Accessed 18.1.2024

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Authors and Affiliations

  1. Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Hufelandstr. 55, 45147, Essen, Germany

    Stephan Settelmeier & Frank Breuckmann

  2. Med. Klinik III—Department for Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Sebastian Steven

  3. Internal Medicine, General and interventional Cardiology, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7–9, 56073, Koblenz, Germany

    Felix Post

  4. Krankenhaus der Augustinerinnen, Department for Cardiology and Intensive Care Medicine, Jakobstr. 27–31, 50678, Köln, Germany

    Ingo Ahrens

  5. Department for Internal Medicine III, Cardiology, Vascular Medicine and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Evangelos Giannitsis

  6. Cardiology, Pneumology, Neurology and Intensive Care Medicine, Klinik Kitzinger Land, Keltenstr. 67, 97318, Kitzingen, Germany

    Frank Breuckmann

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  1. Stephan Settelmeier
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  6. Frank Breuckmann
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Arbeitsgruppe Akuter Thoraxschmerz (AG 44) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK)

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Correspondence to Frank Breuckmann.

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S. Settelmeier, S. Steven, F. Post, I. Ahrens, E. Giannitsis and F. Breuckmann declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Settelmeier, S., Steven, S., Post, F. et al. New categorization of chest pain: noncardiac is in, atypical is out!. Herz (2024). https://doi.org/10.1007/s00059-024-05240-7

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