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Updating an Institutional Chest Pain Algorithm: Incorporating New Evidence on Emerging Pharmacotherapy

Rosner, Gregg F. MD*; Stone, Gregg W. MD*; Stant, Jennifer ACNP*; Burr, Jennifer ACNP*; Tirado, Amelia ACNP*; Collins, Michael MD*; Moses, Jeffrey MD*; Leon, Martin B. MD*; Giglio, James MD; Rabbani, LeRoy E. MD*

doi: 10.1097/HPC.0b013e31825f8da0
Original Articles

Clinical treatment pathways are useful to ensure that evidence-based medicine is consistently applied in hospital systems and have been shown to improve patient outcomes. Such pathways need to be regularly updated and revised by incorporating new evidence from clinical trials to ensure optimal clinical care. In 2011, we published the Columbia University Medical Center/New York Presbyterian Hospital – Clinical Pathways for Acute Coronary Syndromes and Chest Pain. This algorithm includes primary percutaneous coronary intervention for all patients with ST-segment elevation myocardial infarction and an early invasive approach for patients with non–ST-segment elevation myocardial infarction. Since our last chest pain algorithm update, the novel antiplatelet agent ticagrelor has been introduced in the United States, resulting in an important revision of our acute coronary syndrome clinical pathways. Herein, we present our updated chest pain algorithm and provide rationale for the changes that we have made to our protocol.

From the Departments of *Cardiology and Emergency Medicine, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY.

Reprints: LeRoy E. Rabbani, MD, Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center, 173 Fort Washington Ave, Room 4-602, New York, NY 10032. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.