Acute myocardial infarction following a negative evaluation of chest pain

Although acute chest pain accounts for five million emergency room visits annually, only 10% represent acute myocardial infarctions (AMI). Even patients with negative evaluations of chest symptoms experience subsequent cardiac events. Patients readmitted with AMI within 90 days after a cardiac evaluation were examined to identify potential errors in management that may have Led to readmission. Only six of 2,340 patients met criteria for AMI after a negative work-up. No medical errors were found to account for the subsequent AMI. No other previously published reports have investigated the quality of chest pain evaluations to find missed opportunities for cardiac event prevention.