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Many patients present to the emergency department with chest pain. While in most of them chest pain represents a benign complaint, in some patients it underlies a life-threatening illness. We devise an approach for early risk stratification.
We implemented an approach to chest pain that utilizes prediction models such as TIMI, GRACE, and HEART scores along with a fast track strategy that included two sets of cardiac biomarkers within six hours followed by stress echocardiography to determine appropriate early discharge and then followed these patients within 30 days and long-term for major adverse cardiovascular events (MACE). It is felt that those patients who are discharged early will not be found to have any adverse outcomes.
Study is retrospective and involves 440 patients who presented to Cooper University Hospital with chest pain throughout 2010–2011 and monitored in our clinical decision unit (CDU). Inclusion criteria was met if patients were 18 years of age or greater and were in the low to intermediate risk for coronary artery disease. Exclusion criteria included patients presenting with chest pain in the presence of tachyarrhythmia, pulmonary edema, ischemic changes on ECG and patients with baseline biomarkers meeting criteria for AMI. We followed these patients via hospital records, outpatient office visits, and telephone calls to ascertain if there had been any repeat hospitalizations, episodes of chest pain, acute coronary syndrome, cerebrovascular accidents, or death over 1–2 years. The validity of this strategy should be based on the lack of adverse events within 30 days or thereafter.
Utilization of the CDU enabled a rapid and thorough evaluation of the patients’ primary complaint thereby reducing hospitalization costs and occupancy on the one hand and avoiding misdiagnosis in discharged patients on the other. In addition, it allowed for a more comprehensive prediction model to be utilized that facilitates earlier discharge without an increase in adverse cardiovascular events. Lack of major cardiovascular events was observed in all patients and thus validates the strategy utilized for this study.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Pre-Hospital ECG and Transfer: Time Is Myocardium
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1212-182
- 2013 American College of Cardiology Foundation