Acute Coronary Syndrome Screening and Diagnostic Practice Variation.

Area of Science:

• Emergency Medicine
• Cardiology
• Clinical Practice Epidemiology

Background:

• Existing acute coronary syndrome (ACS) guidelines do not direct emergency department (ED) screening and diagnosis implementation.
• This absence leads to variable clinical practices across EDs, potentially impacting patient care.
• Understanding this variability may reveal opportunities for more consistent diagnostic approaches.

Purpose of the Study:

• To characterize the variability in ACS screening and diagnostic practices across diverse EDs.
• To examine three key domains: ECG for STEMI, troponin use for NSTEMI, and noninvasive testing for ischemia.
• To provide data on current ED practices in the absence of specific ACS guidelines.

Main Methods:

• A cross-sectional study analyzing clinical practice epidemiology in 62 diverse EDs.
• Investigated variability in ECG criteria for ST-elevation myocardial infarction (STEMI).
• Assessed troponin biomarker use, risk stratification for non-ST-elevation myocardial infarction (NSTEMI), and noninvasive testing (NIVT) for ischemia.

Main Results:

• 85% of EDs use formal triage for early ECGs; 17% use chest pain alone for STEMI screening.
• For NSTEMI, 58% use ≥4-hour intervals for a second troponin, and 34% risk stratify before troponin.
• Median NIVT use during ED visits is 5%, rising to 61% for in-hospital referral; Coronary CT angiography is used in 66% of EDs.

Conclusions:

• Significant variability exists in ACS screening and diagnostic practices within emergency departments.
• Current practices for diagnosing ACS conditions like STEMI and NSTEMI are inconsistent across facilities.
• Further research is needed to establish standardized guidelines for ACS evaluation in the ED setting.