Evaluación del impacto clínico y la seguridad de una unidad de dolor torácico en pacientes con probabilidad baja e intermedia de síndrome coronario agudo

Abstract

Background: Chest pain units (CPU) are an accepted method to assess patients admitted to anemergency department with chest pain with a potential ischemic origin. Yet in Colombia, thecustomary admission to a CPU in a standardized fashion is scarce and, to our knowledge, theoutcome of implementing recognized protocols for chest pain has not been evaluated.Objective: To assess the clinical impact and security of CPU, in patients with, low and inter-mediate probability of acute coronary syndrome, in Medellín, Colombia.Methods: A descriptive study comprising 277 subjects who were consecutively admitted to theCPU. Variables included demographics, and performance measures to assess the process ofcare (timely action and process completion). A 30 days follow-up included survival and newadmissions compatible with coronary syndromes.Results: From the whole sample, 13.0% of patients were referred for hospitalization. However,only 2.5% had a final diagnosis of an acute coronary syndrome. Median time between receptionand an electrocardiogram acquisition was 10 minutes TIMI score and acute coronary syndromeprobability were reported in 85.5 and 73.9% of subjects respectively. Comparison betweenearly implementation and consolidation phases showed a sensible improvement of performancemeasure indicators (p < 0.05). In addition, 30-day follow-up showed neither fatalities nor newcoronary events.Conclusion: Chest pain observation unit based on clinical assessment of thoracic pain, TIMIrisk score and ST segment changes interpretation in the ECG is a safe and efficacious way tostratify low and intermediate chest pain leading to a safe patient discharge with very low riskof cardiovascular complications.