ABSTRACT
Clinical pathways reinforce best practices and help healthcare institutions standardize care delivery. The NewYork-Presbyterian/Columbia University Irving Medical Center has used such a pathway for the management of patients with chest pain and acute coronary syndromes for almost 2 decades. A multidisciplinary panel of stakeholders serially updates the algorithm according to new data and recently published guidelines. Herein, we present the 2019 version of the clinical pathway. We explain the rationale for changes to the algorithm and describe our experience expanding the pathway to all the 8 affiliated institutions within the NewYork Presbyterian healthcare system.
Subject(s)
Acute Coronary Syndrome/therapy , Chest Pain/therapy , Critical Pathways , Non-ST Elevated Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/therapy , Acute Coronary Syndrome/diagnosis , Adrenergic beta-Antagonists/therapeutic use , Angina, Unstable/diagnosis , Angina, Unstable/therapy , Anticoagulants/therapeutic use , Chest Pain/diagnosis , Coronary Angiography , Electrocardiography , Heparin/therapeutic use , Humans , New York City , Nitroglycerin/therapeutic use , Non-ST Elevated Myocardial Infarction/diagnosis , Patient Transfer , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors/therapeutic use , Practice Guidelines as Topic , ST Elevation Myocardial Infarction/diagnosis , Triage , Troponin I/blood , Troponin T/blood , Vasodilator Agents/therapeutic useABSTRACT
Coronary spasm may present as acute coronary syndrome (ACS), "which can be an ST segment elevation myocardial infarction (STEMI), non-STEMI, or unstable angina." However, the prevalence of coronary spasm in patients with ACS remains unknown due to scarcity of data. Concomitant coronary spasm may mask the true atherosclerosis burden in such cases, posing several management challenges. We illustrate the case of managing an ACS patient with concomitant spasm and atherosclerotic disease. We show that the routine use of vasodilator treatment in ACS cases may prevent inappropriate stenting by identifying concomitant coronary spasm, influencing the clinical outcomes associated with inappropriate stenting in the setting of coronary spasm.
