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Identification of patients in whom chest pain is due to an acute coronary event is among the most challenging problems in emergency medicine. Because of the dangers of missing the diagnosis in patients with a possibly fatal condition, emergency room (ER) physicians often admit patients for 'observation' or 'to rule out MI.' As a result of such a policy, only 30-50% of such patients admitted to the CCU may finally be diagnosed as having an acute myocardial infarction (AMI), resulting in deleterious medical, psychological and economic consequences for the others. A series of 2280 patients who were referred to the ER was followed for 2 weeks. 1362 (59.7%) of those admitted were discharged; 16.1% were hospitalized in the CCU and 83.9% in medical wards. 95 (64.6%) of those hospitalized in the CCU and 97 (12.7%) of those admitted to medical wards had an AMI. The proportion of cases in which hospitalization was unnecessary was 10.2% in the CCU and 29.8% in the medical wards. Unjustified discharges from the ER were 4.3% of referrals. These data are similar to those reported from the USA and from our first study in 1969. It is hoped that by using a triage algorithm in the ER, differentiation between chest pain due to coronary heart disease and that due to other causes will be more accurate and therefore the demand on scarce resources due to unnecessary admissions will be substantially reduced.