Abstract
Introduction: Emergency department clinicians have a difficult task identifying which patients to admit and which patients to discharge home. Of the patients presenting to the emergency department for chest pain, 55 to 85 percent do not have a cardiac cause for their symptoms. Of those admitted for chest pain, more than 60 percent do not have acute coronary syndromes. Unnecessary admissions for chest pain in the U.S. alone cost billions of dollars annually. And the problem of (no monitored bed available) with increasing the length of stay at emergency department. Aim: of the study was improving the management process in patients with Acute Coronary Syndrome and predicts their outcome at the emergency department.
Methods: The study was carried out among 60 patients presenting with non-traumatic chest pain for which no definitive non-ischemic cause was found. Potentially eligible patients were identified in the ED triage area and assessed for study with follow-up throughout their hospital stays for Major Adverse Cardiac Events (MACE).
Results: TIMI risk score has the highest predictive performance of all risk stratification tools, as AUG is greatest (0.93); also, it has the highest sensitivity for MACE (96.5%) Goldman risk score has the highest specificity for MACE (60%). The difference between the tools in predictive ability for MACE was highly significant (p =0.0001).
Conclusion: The results of this study confirm on the value of an integrated approach that involve combined analysis of the clinical history, ECG, troponin levels and early exercise testing in emergency room patients with chest pain.

Key words: Acute coronary syndrome, chest pain, risk stratifications.