Evaluation and outcomes of patients admitted to a tertiary medical assessment unit with acute chest pain of possible coronary origin.

  • Scott I
  • Aggarwal L
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Abstract

OBJECTIVES: The study aims to (i) profile clinical characteristics, risk estimates of acute coronary syndrome (ACS), use and yield of non-invasive cardiac testing, discharge diagnosis and 30-day outcomes among patients admitted with acute chest pain of possible coronary origin; and (ii) construct a risk stratification algorithm that informs management decisions., METHODS: This is a retrospective cohort study of 130 consecutive patients admitted to a tertiary hospital medical assessment unit between 24 January and 22 March 2012. Estimates of ACS risk were based on Australian guidelines and Thrombolysis in Myocardial Infarction (TIMI) scores., RESULTS: Patients were of mean age 61 years, 45% had known coronary artery disease (CAD), 58% presented with typical ischaemic pain, 82% had intermediate to high ACS risk and 61% underwent testing. Myocardial ischaemia was cardiologist-confirmed discharge diagnosis in 29% of patients, and was associated with known CAD, typical pain, multiple risk factors and high TIMI risk scores (P < 0.001 for all associations). Of 98 non-invasive investigations, 9% (95% CI, 5-17%) were positive for myocardial ischaemia. Major adverse event rate at 30 days was 0.8% (95% CI,

Author-supplied keywords

  • *Acute Coronary Syndrome/di [Diagnosis]
  • *Chest Pain/di [Diagnosis]
  • Acute Coronary Syndrome/co [Complications]
  • Adult
  • Aged
  • Algorithms
  • Australia
  • Chest Pain/et [Etiology]
  • Emergency Service, Hospital/sn [Statistics & Numer
  • Female
  • Humans
  • Length of Stay/sn [Statistics & Numerical Data]
  • Male
  • Middle Aged
  • Myocardial Ischemia/co [Complications]
  • Myocardial Ischemia/di [Diagnosis]
  • Retrospective Studies
  • Risk Assessment/mt [Methods]
  • Risk Factors
  • Tertiary Care Centers

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Authors

  • Ian A Scott

  • Leena Aggarwal

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