Diagnosis of acute coronary syndrome in the primary care in Colombia and indications for emergent transfer at a higher level of complexity, is it possible without cardiac enzymes?

Abstract

Chest pain is a frequent complaint in the emergency department, and the lack of timely diagnosis of the acute coronary syndrome is associated with high mortality and malpractice lawsuits. There are multiple algorithms to rule out this disease; however, they are desig-ned for institutions with the availability of cardiac biomarkers; In Co-lombia, few primary care settings have these. This article reviews the tools that have been described in the literature to rule out this diagnosis in the low-complexity emergency department. There are three scales: Vancouver Chest Pain Rule, INTERCHEST, and Marburg Heart; the latter has the most evidence with some limitations as it was developed in the context of intermittent and non-acute pain. We propose a diagnostic algorithm including physical findings, electro-cardiogram, and prediction scales.