Doubts with acute coronary syndrome patients following the prospective analysis

We evaluated patients with chest pain admitted to Firat University Hospıtal Emergency department and compared mortality and morbidity in whom acute coronary syndrome (ACS) diagnosed and in whom non-specific chest pain was thought and discharged from emergency department. And we aimed to investigate the approprateness of invasive and non-invasive procedures and find out the inapproprate resource expenditure.A total of 400 patients were included to study between Jan 2008-Jan 2009 admitted to emergency department. Three hundred of them were hospitalized to cardiology clinic with the diagnosis of ACS 100 of them were discharged from emergency department with non-specific chest pain. ACS patients and discharged patients were compared. We also compared the patients in ACS group after coronary angigraphy according to presence or absence of angiographicly proven disease. We compared the patients dicharged from emergency department according to presence or absence of coronary artey disease demostrated by invasive or non-invasi methods.Coronary artery disease was seen in 262 (87.33%) and normal coronary artery was seen in 38 (12.67%) of patients hospitalized ACS diagnosis. Coronary artery disease was seen in 16 (16%) and normal coronary artery was seen in 84 (84%) of patients discharged from emergency department. There was a significant difference between normal coronary artery and coronary artery proven patients with respect to age, sex, diabetes mellitus, dyslipidemia and first and second TnI levels in hospitalized ACS group (p<0,05). There was a significant difference between normal coronary artery and coronary artery proven patients with respect to diabetes mellitus, dyslipidemia, cigarettes, CK MB and second TnI levels in patients discharged from emergency department (p<0,05). But any difference was observed in first TnI levels.In conclusion, we think that those patients with normal troponin level and ECG at admission sholud be observed for 10-12 hours and serial ECG?s and a second cardiac troponin should be obtained. And those patients with normal troponin and ECG can be discharged safely. We think that establisment of chest pain unit in emergency department is necessary for optimal management of these patients. Thus the ratio of false positive and false negative diagnosis were decreased and by this way both mortality and morbidity, and unnecessary source expeniture can be decreased.Key words: Acute coronary synromes, chest pain unit, cardiac troponins