Introduction: Acute coronary syndromes (ACS) are leading life threatening causes of chest pain, which is one of the most common complaints in the emergency department (ED). The aim of the study was to demonstrate the usefulness of physical examination, ECG and cardiac markers to predict short term outcome of ACS patients. Methods: A total of 1728 patients with chest pain were evaluated between 1st January 2003 and 31st December 2003 in the ED and 236 of the patients matched our study criteria. Results: In the study group 184 patients were (78%) male and the mean age was 59.8±12.2 (range=4-92) years old. Age, Killip score, cardiac marker values, the time interval between the beginning of the chest pain and ED entry and the ECG changes were the studied variables. With the logistic regression analysis, Killip score and any rhythm other than normal sinus rhythm on the first ECG were found to be the only independent variables to predict early mortality (p=0.036 and p=0.033). Conclusion: Simple measures in the ED such as ECG and serum markers of myocardial injury along with the thorough physical evaluation of the physician may predict early negative outcome.