Is it possible to reduce time to appropriate treatment of acute coronary syndrome through a faster diagnosis? Focus on future innovative technologies and related treatments

Abstract

Patients with chest pain represent 5% of the total Emergency Department (ED) presentations and among these only 5–15% receive a final diagnosis of acute coronary syndrome (ACS), while up to 2% are still discharged with a missed ACS diagnosis. The diagnosis of ACS depends on a combination of clinical symptoms, ECG findings, and cardiac biomarkers. ACS management starts from the prehospital setting, where the use of successful networks, efficient emergency medical systems and telemedicine, combined with patient education campaigns, has proved to improved survival. Unfortunately, at ED arrival, ACS diagnosis still represents a challenge for emergency physicians, whereas clinical presentations can be widely variable and the diagnostic tools available are still quite limited. While the 12-lead ECG is the first-line test, it could be often non diagnostic so the experimental use of innovative and more accurate device seems to overcome its limits. Moreover, the introduction of high-sensitivity or ultrasensitive troponins assays and point-of-care (POCT) testing for troponins have proved their utility, reducing the time to rule-in and to rule-out for patients presenting with chest pain since ED admission. As soon as ACS is diagnosed, it is mandatory to immediately start treatment, according to guidelines. This is even more important in the era of innovative and emerging P2Y12 inhibitors that have shown to play an important benefit for ACS treatment. The aim of this article is to show the ideal approach to ACS, from symptom onset to early treatment in the ED, to show innovative tools for ACS diagnosis and treatment in order to improve outcome for these patients.