The diagnosis of non ST acute coronary syndrome (NSTACS) is difficult in emergency medicine, particularly for patients classified as low risk according to the guidelines of the European Society of Cardiology. For those, it is impossible to differentiate an ACS from another diagnosis. It is recommended to perform a cardiology consultation early after their discharge to emergency rooms. With the collaboration of cardiologists, a consultation has been established to review these patients at an early stage (less than 4 days). The aim of our study was to assess the characteristics of patients who have benefitted from this consultation, the cardiac diagnostic tests performed and the final diagnosis assigned by the cardiologist.

A retrospective study was conducted from January to August 2009 with an analysis of the reports of consultations for patients discharged from emergency room with suspected low risk ACS diagnosis. Descriptive analysis was performed. Results: During 8 months, 198 patients (68%) were assessed (60% of men with an average age of 51 years). For cardiologists, 40% had a pain-like angina. The risk factors were hypertension (20%), coronary family history (22%), current smoking (46%), diabetes (10%), hypercholesterolemia (25%). The electrocardiogram was in favor of an ACS in 8% of cases. The patients underwent a further cardiac tests in 76% of cases: stress test (56%), Multidetector Computed Tomography (10%), stress echocardiography (6%), myocardial scintigraphy (8%), coronarography (14%), transthoracic echocardiography (22%), 3 myocardial MRI. ACS diagnosis were confirmed only in 6 patients (3%). The other diagnostic hypotheses have been proposed for 63 patients. In total, 65% remained pain free diagnosis.

ACS diagnosis is difficult for patients classified low risk after emergency room discharge. Few of ACS were diagnosed after the cardiology consultation and the majority of patients had no diagnosis retained.