LIBRARY

Recently I had a chance to attend the European Symposium on Acute Coronary Syndrome Denmark, that will be published in the Lancet in the very near future. The meeting was held in Copenhagen Denmark and represented a great deal of input from European countries. It was at this meeting that I recognized the true importance of the efforts being made by the Society of Chest Pain Centers that has started in the United States. If you recall, we did not call our Society "The American Society of Chest Pain Centers and Providers" because we did not want to limit to the United States alone. We felt this eventually would become a worldwide effort not only in terms of the chest pain center development but also in terms of the awareness program for early recognition of patients within communities of the world manifesting the early signs of acute myocardial ischemia. At this European meeting I was much impressed with the evidence based data that was presented with the many studies so far completed but when it came time to summarize the conference what was decidedly lacking was any true effort to reduce time to treatment in patients with acute coronary syndrome. I brought this to the attention of the speaker and audience at the wrap up session. There was agreement that timely application of present day therapy needs to take place in patients with acute coronary syndrome but that it was not easy to do. I then realized the importance of the Chest Pain Center development that has taken place within the United States in that this strategy allows us to see the importance of the low probability of ischemic disease work up providing efficiency and cost effectiveness and that the emerging focus on reducing time to treatment in patients with acute coronary syndrome through awareness programs will help us to apply the science in a more preventive manner. The reason why this was not discussed at the Lancet Conference was because Chest Pain Centers have only begun to develop within the European area and thus lacks the cohesiveness that is now developing within the United States. This became very clear to me at that time and hopefully you will have the vision to understand this difference.

Chest Pain Centers represent a potential delivery system to earlier heart attack care within the hospitals community. We know that reducing time to treatment is important in patients with acute myocardial infarction but this still is a late manifestation of the problem. Patients with acute coronary syndrome have not crashed as yet and in many instances are having such symptoms in the community. In our efforts to capture such patients we need to develop effective awareness programs. The difference in mortality between prodromal myocardial infarction patients and prodromal unstable angina patients was 6% compared to 3% in the Gusto II Study. Thus capturing prodromal unstable angina patients before they infarct significantly reduces mortality. It is true that we are not there yet but the Society of Chest Pain Centers and Providers representing the partnership of emergency physicians, cardiologists and critical care nurses can contribute greatly by helping to develop teamwork at the community level. As one can easily see this involves not only the hospital preparedness but also preparedness and education within the community that involves not only the EMS but also educators at various levels. Does our Society have the ability to achieve these goals? Only the test of time will give an answer to such a question but there is no doubt that there is a great need in addressing the nations number one health problem for us to pull together. The Chest Pain Center Strategy represents an earnest effort to develop a delivery system that will enable us to develop community penetration where present day medical progress is most effective.