Markers and the initial triage and treatment of patients with chest pain.

Emergency departments evaluate nearly 8 million patients with chest pain per year. Nearly 4 million of these individuals are admitted to inpatient units for further evaluation and treatment, but only 30% of these admitted patients ultimately have the diagnosis of acute coronary syndrome (ACS). Previously, the initial evaluation of patients with chest discomfort presenting to the emergency department (ED) involved the triad of history, physical, and ECG. Current evidence demonstrates that a fourth element, cardiac markers, serves as a valuable aid in not only determining initial diagnosis but also providing risk stratification and dictating initial patient treatment. Chest pain units (CPUs) using serial marker determinations have been successful in identifying patients with or at risk for adverse cardiac events in a timely and cost- efficient manner. New point-of-care-testing (POCT) of cardiac markers at the patient's bedside allows for even more timely determination. This article will review the use of cardiac markers in heterogeneous patients presenting to EDs with chest discomfort. We will focus on the use of markers in the risk stratification and initial treatment of the ED chest pain population and emphasize the role of CPUs and POCT.