Figure 6. Proposed decision algorithm for managing chest pain in the emergency department. This flowchart outlines a comprehensive approach for the evaluation and management of patients presenting with chest pain in the emergency department. The algorithm incorporates both traditional and nuanced diagnostic criteria, aiming to improve the identification and treatment of Occlusion Myocardial Infarction (OMI). Key steps include initial clinical assessment, rapid electrocardiogram (ECG) evaluation, and consideration of both ST-segment elevation (STE) and other ECG signs. The algorithm also accounts for the possibility of false-negative OMI cases, emphasizing the importance of monitoring for refractory chest pain or dynamic changes in ECG as indicators for immediate reperfusion therapy. It is important to note that while this proposed algorithm offers a potential advancement in the management of chest pain, its implementation on a national scale, particularly within Brazil's Universal Healthcare System, may lead to an increase in the number of primary percutaneous coronary interventions. Therefore, the logistics and economic implications of this proposal should be carefully considered, and further validated through randomized controlled trials before widespread adoption.