Table 8.
Relevant changes of the criteria of the German Society of Cardiology for Chest Pain Unit: 2008 to 2014
| Criterium | 2008 Minimal requirements | Additional recommendations | 2014 Minimal requirements | Additional recommendations |
|---|---|---|---|---|
| Rhythm monitoring | At each bed | ST-segment monitoring | At each bed | ST-segment monitoring omitted |
| Exercise testing, CT-scan coronary arteries | Available within three business days; an appointment must be given upon discharge and entered in the discharge letter; when possible, in cooperation with outpatient clinics | Located in the CPU | Available within three business days; an appointment must be given upon discharge and entered in the discharge letter | When possible, in cooperation with outpatient clinics |
| Laboratory values (cardiac) | Troponin T or I | CK, CK-MB, BNP, nt-proBNP, multimarker, Myoglobin | Troponin T or I | hsTroponin T, BNP, Nt-proBNP, Copeptin (new) (multimarker and myoglobin omitted) |
| Timing of determination of laboratory values | 0 + 6 to 12 h after admission | 0–3–6 h, additional sampling after another chest pain event | 0 + 6 and up to 9 h after admission | 0–3 h in case of use of hsTroponin T, additional sampling after another Chest Pain Attack, 0–1 (2) h in case of hsTn assays in patients with low risk |
| Laboratory values (general) | Electrolytes, creatinine, blood count, CRP, coagulation status | Additional diagnostics, thyroid function tests (TSH), (repeated) D-Dimer if clinically indicated | Electrolytes, creatinine, blood count, CRP, coagulation status, D-Dimer if clinically indicated (now minimal requirement) | Additional diagnostics when indicated, thyroid function tests (TSH) |
| TTE | All unstable patients, based on clinical indications. Available on 365 days/24 h | All patients with ACS or other clinical indications—365 days/24 h availability | ||
| Risk stratification (new) | GRACE-score at admission | Additional risk scores | ||
| Algorithms for patients` treatment | STEMI (two different algorithms for patients with in-hospital and pre-hospital diagnosis), NSTEMI, unstable angina pectoris, stable angina pectoris, hypertensive crisis, acute lung embolism, acute aortic dissection, cardiogenic shock, resuscitation | Additional algorithms | STEMI (two different algorithms for patients with in-hospital and pre-hospital diagnosis), NSTEMI, unstable angina pectoris, stable angina pectoris, hypertensive crisis, acute lung embolism, acute aortic dissection, cardiogenic shock, resuscitation, ICD discharge, SM-malfunction, atrial fibrillation (new) | Additional algorithms |
| Catheterization laboratory accessibility | Every STEMI within 90–120 min, every NSTEMI/UA with moderate to high risk 48–72 h | Every STEMI within 90–120 min (contact-to-balloon time), patients with NSTEMI/UA with very high risk: immediately; with high risk (GRACE > 140) within 24 h; with low risk: within 72 h, or according to most current guidelines | ||
| Emergency services | Integration in the regional plan for ACS | Integration in the existing emergency system | Integrated structures for the therapy of ACS at a regional and nationwide | |
| Catheterization laboratory | Available 365 days/24 h, transfer time <15 min, with at least four interventional cardiologists | Available 365 days/24 h, transfer time <15 min (the criterion of at least four cardiologists is deleted) | ||
| Additional cooperations | Gastroenterology, heart surgery, outpatient clinics | Psychosomatic medicine | Heart surgery, outpatient clinics, gastroenterology is omitted | Other disciplines Psychosomatic medicine is omitted |
| Nursing staff | Presence: 365 days/24 h | Intensive care unit training | Special CPU training | Accredited training as Nurse expert (Chest Pain Unit), intensive care unit training |
| Quality control | Feedback mechanisms for the assessment of the quality of the diagnostic and therapy | Participation in the CPU-registry |
Changes are highlighted in italic