A cohort study of adults with a first episode of chest pain (no previous record of cardiovascular disease) presenting to 223 general practices in the UK found:
Most patients had no diagnosis attributed at presentation (72.4%)
Most patients still had no diagnosis attributed within the next 6 months
Those patients who had no diagnosis attributed to their chest pain at 6 months had a higher long-term incidence of cardiovascular events compared with patients who had been diagnosed with non-coronary pain.
Chest pain is a common chief complaint, accounting for 5% to 8% of all emergency department visits in the US per year.  It is the presenting complaint in 1% to 2% of clinic-based visits.  In the UK, 1% to 2% of adults attend primary care each year with a new presentation of chest pain.    In Belgium and the Netherlands, chest pain was present in about 1% of patient consultations across 118 primary care centres over a 2-week period. 
Chest pain may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and non-cardiac causes. Acute coronary syndrome (ACS), encompassing unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI), may not be the most common aetiology in patients presenting with chest pain, but excluding ACS is vital because of the mortality associated with untreated MI.
This topic concentrates on the assessment of acute chest pain in the emergency setting.
Professor and Chair
Wright State University Boonshoft School of Medicine
JEB declares that he has been engaged as an expert witness in cases involving the evaluation of patients with chest pain.
Dr James E. Brown would like to gratefully acknowledge Dr Marvin H. Eng and Dr Mori J. Krantz, previous contributors to this monograph. MHE declares that he has no competing interests. MJK is a consultant for GlaxoSmithKline.
St Vincent’s Hospital Melbourne
Department of Medicine
University of Melbourne
MJ declares that he has no competing interests.
Gill Foundation Professor of Interventional Cardiology
Director of Cardiac Catheterization Laboratories
Gill Heart Institute
Division of Cardiovascular Medicine
University of Kentucky
DM declares that he has no competing interests.
University of Michigan Congenital Heart Center
MB declares that he has no competing interests.
Department of Internal Medicine
University of Colorado Health Sciences Center
EC declares that he has no competing interests.
Albert Einstein College of Medicine/Jacobi Medical Center
DS declares that he has no competing interests.
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