Systematic reviews of the diagnostic value of clinical features
in the assessment of chest pain have largely been carried
out in hospital settings,4 where the prevalence of serious
disease is higher than in general practice. It is widely understood
that no single clinical feature or combination of features
can be used to exclude ACS with sufficient sensitivity to
obviate the need for further investigation. Thus, a strategic
approach based on clinical risk stratification, a period of
observation, electrocardiography and serial biomarker evaluation
has emerged. In all settings, a 12-lead electrocardiogram
(ECG) should be performed immediately in patients presenting
acutely with chest pain to exclude ST-segment-elevation.