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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

Distribution of imaging tests between the study groups.MPS, Myocardial perfusion scintigraphy; MDCT, Multidetector computed tomography; Echo, Stress echocardiography; CAD, Coronary artery disease.
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pone.0163501.g002: Distribution of imaging tests between the study groups.MPS, Myocardial perfusion scintigraphy; MDCT, Multidetector computed tomography; Echo, Stress echocardiography; CAD, Coronary artery disease.

Mentions: As shown in Fig 2, patients without a history of prior CAD underwent significantly more evaluation tests with MDCT than with MPS, compared with those patients who had a history of prior CAD (47% vs. 4%, p value < 0.001 for MDCT, 47% vs. 92%, p value <0.001 for MPS). When comparing between patients with and without a history of prior CAD, both groups were similar regarding discharge after non-invasive evaluation (91% vs. 87%, p = 0.08, respectively). Furthermore, there was no difference between the two groups regarding hospitalization rates (9% vs. 13%, p = 0.08), coronary angiography (13% vs. 11%, p = 0.4), and revascularization (6% vs. 5.2%, p = 0.7) (Table 3). Overall, 73 patients underwent revascularization during hospitalization in the CPU. Of them, 25 patients underwent revascularization during the observation period prior to non-invasive evaluation, and 48 patients after undergoing non-invasive evaluation.


Feasibility and Safety of Evaluating Patients with Prior Coronary Artery Disease Using an Accelerated Diagnostic Algorithm in a Chest Pain Unit
Distribution of imaging tests between the study groups.MPS, Myocardial perfusion scintigraphy; MDCT, Multidetector computed tomography; Echo, Stress echocardiography; CAD, Coronary artery disease.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0163501.g002: Distribution of imaging tests between the study groups.MPS, Myocardial perfusion scintigraphy; MDCT, Multidetector computed tomography; Echo, Stress echocardiography; CAD, Coronary artery disease.
Mentions: As shown in Fig 2, patients without a history of prior CAD underwent significantly more evaluation tests with MDCT than with MPS, compared with those patients who had a history of prior CAD (47% vs. 4%, p value < 0.001 for MDCT, 47% vs. 92%, p value <0.001 for MPS). When comparing between patients with and without a history of prior CAD, both groups were similar regarding discharge after non-invasive evaluation (91% vs. 87%, p = 0.08, respectively). Furthermore, there was no difference between the two groups regarding hospitalization rates (9% vs. 13%, p = 0.08), coronary angiography (13% vs. 11%, p = 0.4), and revascularization (6% vs. 5.2%, p = 0.7) (Table 3). Overall, 73 patients underwent revascularization during hospitalization in the CPU. Of them, 25 patients underwent revascularization during the observation period prior to non-invasive evaluation, and 48 patients after undergoing non-invasive evaluation.

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