Is cardiac monitoring necessary for intermediate risk acute coronary syndrome patients who have a normal electrocardiogram and cardiac markers in the emergency department?

This study aimed to investigate the safety of managing selected patients with suspected acute coronary syndrome without cardiac monitoring by determining the rate of complications occurring in chest pain patients classified as intermediate risk according to the National Heart Foundation of Australia guidelines and with normal cardiac marker levels and a normal/unchanged ECG in the emergency department. One patient suffered a critical adverse event within 24 hours (0.3%, 95% CI 0.1-1.7%) and 24 patients suffered other adverse events (6.3%, 95% CI 4.2-9.4%). This study provides further evidence that this group of patients are at low risk of experiencing a critical adverse event within 24 hours of hospital presentation and may be safely managed without continuous cardiac monitoring.