Management of Chest Pain in the Emergency Department: The Role of Dedicated Pathways and Specialist Consultation at Aorn Cardarelli

Background Chest pain is one of the most frequent and challenging reasons for admission to the Emergency Department (ED), requiring rapid triage and precise diagnostic stratification to distinguish life–threatening cardiovascular events from benign conditions. At AORN Cardarelli, the management of these patients is standardized through a specific Diagnostic–Therapeutic Diagnostic Pathway (PDTA) for Chest Pain. This study analyses the clinical flow and outcomes of patients presenting with chest pain in 2025, emphasizing the integration between the ED and the Intensive Cardiac Care Unit (UTIC). Materials and Methods A retrospective analysis was conducted on all patients who accessed the AORN Cardarelli ED for chest pain during the year 2025. Data were extracted from electronic health records, focusing on the adherence to the institutional PDTA. The clinical pathway involves immediate ECG execution, serial troponin dosage, and the early involvement of a cardiologist as a consultant directly within the ED. The study focused on the distribution of diagnoses among hospitalized patients and the impact of the cardiologist’s presence on appropriateness of admission. Results In 2025, approximately 3,500 patients accessed the ED for chest pain. Following initial screening, 35–40% (n=1,400) required admission to the UTIC. Within this hospitalized cohort, the distribution of Acute Coronary Syndromes (ACS) was as follows: about 20–25% were ST–Elevation Myocardial Infarctions (STEMI), about 35–40% were Non–ST–Elevation Myocardial Infarctions (NSTEMI). The data demonstrate that the presence of a dedicated cardiologist in the ED significantly streamlined the “door–to–diagnosis“ time. Furthermore, this integrated model led to a measurable reduction in “inappropriate admissions”, ensuring that UTIC beds were prioritized for high–risk patients while safely discharging or redirecting low–risk cases. Conclusions The management of chest pain at AORN Cardarelli highlights the efficacy of a structured PDTA combined with early specialist intervention. The 2025 data confirm that a significant portion of chest pain admissions corresponds to high–acuity ACS cases, justifying the intensive resource allocation. The role of the cardiologist as a consultant in the ED is a cornerstone of this success, providing the expertise necessary to speed up life–saving treatments for STEMI/NSTEMI patients and minimize the clinical and economic burden of unnecessary hospitalizations.