Acute chest pain--identification of patients at low risk for coronary events. The impact of symptoms, medical history and risk factors.

Background: The evaluation of patients with acute chest pain remains challenging, as it implies the risk of fatal misdiagnosis. It is well recognized that typical angina does not specifically identify patients at high risk. We investigated the predictive value of characteristics atypical for myocardial ischemia for exclusion of acute or subacute coronary events, focusing on patients' symptoms, medical history and risk factors.

Acute chest pain-a stepwise approach, the challenge of the correct clinical diagnosis.

Study Objective: To assess the safety and the accuracy of a 4 h stepwise diagnostic approach relying on clinical judgement in unselected patients with acute chest pain.

Design: Prospective cohort study.

Setting: Emergency department (ED) of a tertiary care university hospital.