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Chest pain research in Australasian emergency medicine: Putting our mark on the world stage

The ASia Pacific Evaluation of Chest Pain (ASPECT) 2 h rule out study published recently in the Lancet was a landmark article for Australasian emergency medicine. The authors Than et al. are to be congratulated on a major achievement for Australasian emergency medicine research. In an area dominated by American and European work, they have managed a number of special successes. Than et al. produced a high-quality paper using an excellent new methodology, and it was published in a major general medical journal. The lead authors did this with the significant disadvantage of being away from the usual geographical area of interest of both biomedical journals and the drug industry. They also included many centres from developing Asian emergency medicine systems, at the same time setting up a network of collaboration and goodwill in this region. Finally, they adopted a new, comprehensive standardized data definitions set that will facilitate comparative analysis of acute coronary syndrome (ACS) research internationally. As EDs provide the initial risk analysis, screening and management of the majority of patients with chest pain, they often have to organize follow up for nonadmitted patients. It is therefore vital that emergency physicians have a voice in the debate about how these patients are managed, given the huge resources and capacity they utilize within the emergency medical system. As antipodean emergency physicians, we owe Than et al. a great debt for their perseverance and fortitude putting together a large multicentre trial, with such meticulous attention to sound methodology in an area of great interest to the health community. Emergency medicine will be rightly recognized as being at the forefront in the future management of the entirety of patients who present with chest pain. The article was also important as it used new, standardized ACS research-adjudicated criteria, agreed upon by the authors along with recognized experts from the USA and Europe. These adjudication criteria are vital to allow a consistent approach to chest pain and cardiac biomarker research, which in the past has been hampered by a lack of consistency in definitions. These criteria will allow proper comparisons and metaanalysis of future studies. The fruits of this are already occurring with other studies using these criteria, for instance, from Perth (Y. Nagree, pers. comm., 2011) and both our own research groups that are using these criteria. The ability to compare between international groups will lead to better generalization when analysing trials from different regions. It will also help speed up the adoption of proven new strategies, and counter concerns about different cohort populations and different data usage. The ASPECT paper itself showed that a combination of objective risk stratification using a validated scoring system, and a negative set of repeated bedside