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Feasibility and Safety of Evaluating Patients with Prior Coronary Artery Disease Using an Accelerated Diagnostic Algorithm in a Chest Pain Unit

View Article: PubMed Central - PubMed

ABSTRACT

An accelerated diagnostic protocol for evaluating low-risk patients with acute chest pain in a cardiologist-based chest pain unit (CPU) is widely employed today. However, limited data exist regarding the feasibility of such an algorithm for patients with a history of prior coronary artery disease (CAD). The aim of the current study was to assess the feasibility and safety of evaluating patients with a history of prior CAD using an accelerated diagnostic protocol. We evaluated 1,220 consecutive patients presenting with acute chest pain and hospitalized in our CPU. Patients were stratified according to whether they had a history of prior CAD or not. The primary composite outcome was defined as a composite of readmission due to chest pain, acute coronary syndrome, coronary revascularization, or death during a 60-day follow-up period. Overall, 268 (22%) patients had a history of prior CAD. Non-invasive evaluation was performed in 1,112 (91%) patients. While patients with a history of prior CAD had more comorbidities, the two study groups were similar regarding hospitalization rates (9% vs. 13%, p = 0.08), coronary angiography (13% vs. 11%, p = 0.41), and revascularization (6.5% vs. 5.7%, p = 0.8) performed during CPU evaluation. At 60-days the primary endpoint was observed in 12 (1.6%) and 6 (3.2%) patients without and with a history of prior CAD, respectively (p = 0.836). No mortalities were recorded. To conclude, Patients with a history of prior CAD can be expeditiously and safely evaluated using an accelerated diagnostic protocol in a CPU with outcomes not differing from patients without such a history.

No MeSH data available.


Related in: MedlinePlus

Patient evaluation flow chart.* Patients with a negative evaluation were discharged. # Positive evaluation includes: hospitalization during the observation period in the chest pain unit and patients with a positive non-invasive tests who were hospitalized for further investigation. CAD, Coronary artery disease; CPU, Chest pain unit
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pone.0163501.g001: Patient evaluation flow chart.* Patients with a negative evaluation were discharged. # Positive evaluation includes: hospitalization during the observation period in the chest pain unit and patients with a positive non-invasive tests who were hospitalized for further investigation. CAD, Coronary artery disease; CPU, Chest pain unit

Mentions: A patient evaluation flow chart is shown in Fig 1. Fifty patients (4.1%) who had an uneventful course during the observation period in the CPU were discharged after clinical evaluation without further non-invasive testing. Fourteen patients (28%) had a history of prior CAD and 36 (72%) did not. The remaining 1,112 (91%) patients underwent non-invasive testing: 623 patients (56%) MPS, 423 (38%) MDCT, and 66 (6%) stress echocardiography. Of these 1,112 patients, 1002 (90%) were discharged without further investigation. None of the patients died during the evaluation period in the CPU.


Feasibility and Safety of Evaluating Patients with Prior Coronary Artery Disease Using an Accelerated Diagnostic Algorithm in a Chest Pain Unit
Patient evaluation flow chart.* Patients with a negative evaluation were discharged. # Positive evaluation includes: hospitalization during the observation period in the chest pain unit and patients with a positive non-invasive tests who were hospitalized for further investigation. CAD, Coronary artery disease; CPU, Chest pain unit
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036881&req=5

pone.0163501.g001: Patient evaluation flow chart.* Patients with a negative evaluation were discharged. # Positive evaluation includes: hospitalization during the observation period in the chest pain unit and patients with a positive non-invasive tests who were hospitalized for further investigation. CAD, Coronary artery disease; CPU, Chest pain unit
Mentions: A patient evaluation flow chart is shown in Fig 1. Fifty patients (4.1%) who had an uneventful course during the observation period in the CPU were discharged after clinical evaluation without further non-invasive testing. Fourteen patients (28%) had a history of prior CAD and 36 (72%) did not. The remaining 1,112 (91%) patients underwent non-invasive testing: 623 patients (56%) MPS, 423 (38%) MDCT, and 66 (6%) stress echocardiography. Of these 1,112 patients, 1002 (90%) were discharged without further investigation. None of the patients died during the evaluation period in the CPU.

View Article: PubMed Central - PubMed

ABSTRACT

An accelerated diagnostic protocol for evaluating low-risk patients with acute chest pain in a cardiologist-based chest pain unit (CPU) is widely employed today. However, limited data exist regarding the feasibility of such an algorithm for patients with a history of prior coronary artery disease (CAD). The aim of the current study was to assess the feasibility and safety of evaluating patients with a history of prior CAD using an accelerated diagnostic protocol. We evaluated 1,220 consecutive patients presenting with acute chest pain and hospitalized in our CPU. Patients were stratified according to whether they had a history of prior CAD or not. The primary composite outcome was defined as a composite of readmission due to chest pain, acute coronary syndrome, coronary revascularization, or death during a 60-day follow-up period. Overall, 268 (22%) patients had a history of prior CAD. Non-invasive evaluation was performed in 1,112 (91%) patients. While patients with a history of prior CAD had more comorbidities, the two study groups were similar regarding hospitalization rates (9% vs. 13%, p = 0.08), coronary angiography (13% vs. 11%, p = 0.41), and revascularization (6.5% vs. 5.7%, p = 0.8) performed during CPU evaluation. At 60-days the primary endpoint was observed in 12 (1.6%) and 6 (3.2%) patients without and with a history of prior CAD, respectively (p = 0.836). No mortalities were recorded. To conclude, Patients with a history of prior CAD can be expeditiously and safely evaluated using an accelerated diagnostic protocol in a CPU with outcomes not differing from patients without such a history.

No MeSH data available.


Related in: MedlinePlus