Approach to the ED Patient with "Low-Risk" Chest Pain

Patients who present to the ED with chest pain (or its equivalent) but have no electrocardiographic changes or elevation in cardiac biomarkers after an appropriate interval can be considered low risk for acute coronary syndrome. Combined with a low demographic risk for coronary artery disease (eg, using Framingham criteria), such patients can be said to be "low risk" for a subsequent coronary event. Whether there is a role for further risk stratification with provocative testing and/or coronary imaging before discharge remains open to debate.