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Emergency Department Management of Non–ST-Segment Elevation Myocardial Infarction
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Approximately 2% of patients presenting to an ED with acute coronary syndromes (ACS) are misdiagnosed and subsequently discharged.
Misdiagnosis is more common among women aged < 55 years, and all patients of nonwhite ethnicity, patients with the presenting complaint of dyspnea, and patients with normal or nondiagnostic ECGs.
Failure to hospitalize patients with ACS nearly doubles their mortality risk.
The 1-year case fatality rate for patients with NSTEMI (non–ST-segment elevation myocardial infarction) is ≈ 25%, more than double that of STEMI.
The American Heart Association and American College of Cardiology (AHA/ACC) guidelines on NSTEMI have been criticized due to potential conflicts of interest with the pharmaceutical industry.