Conclusion

Modeled on the success of the coronary care units, chest pain centers provide a comprehensive manage-ment strategy for the evaluation, triage, and appro-priate treatment of chest pain patients [14]. Newer treatment options offer greater benefits to early, aggressive intervention. Chest pain centers also edu-cate patients about prodromal symptoms and emphasize the benefits of early treatment, before progres-sion to an acute myocardial infarction.

The rapid growth in the number of chest pain centers has been driven by reports that demonstrate this approach to be not only highly effective in treating acute myocardial infarction patients but also a cost-effective method of evaluating ischemia pa-tients with low-to-moderate risk of a heart attack. Chest pain centers also promote highly aggressive cardiac outreach programs that encourage patients with early chest pain to come in for evaluation and treatment if necessary [11,50].

The ultimate success of chest pain centers will be demonstrated by a significant decrease in the mortali-ty associated with heart attacks. Achieving this goal will require consistent rapid evaluation and treatment of infarction patients; detection of atypical infarcts and unstable angina; earlier intervention with newer therapeutic agents; reduction of the event-to-door time; and intervention during prodromal episodes. These latter strategies require educational campaigns to promote the need to recognize and seek treatment for prodromal symptoms. The strategy of the chest pain center is aimed at the most vulnerable phase of the heart attack cycle - the prodromal unstable angina phase - and can reshape our approach to solving the heart attack problem.

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