The PAIN Pathway for the Management of Acute Coronary Syndrome

Acute coronary syndrome (ACS) subsumes a spectrum of clinical entities, ranging from unstable angina to ST-elevation myocardial infarction [1]. The management of ACS is deservedly scrutinized, as it accounts for 2 million hos-pitalizations and a remarkable 30% of all deaths in the Unites States each year [2]. Clinical guidelines on the management of ACS, which are based on clinical trials, have been updated and published [3, 4].

Large-scale registries—the NRMI [5], CRUSADE [6], and GRACE [7] registries—have consistently demonstrated a major gap between ACS management guidelines and their practical application in the real world. Accordingly, a major message that emerges from these quality-improvement registries is that there is an urgent need to incorporate the evidence-based guidelines into our daily management of ACS. In an attempt to achieve this goal, we have developed a new pathway for the management of ACS at our institution, St. Luke's Roosevelt Hospital Center (SLRHC), which is a university hospital of Columbia University College of Physicians and Surgeons. The necessity to develop such a pathway at our institution is compelling yet typical of the need at many similar medical centers.