Abstract
The optimal diagnostic evaluation of patients presenting to the emergency department
(ED) with chest pain but without myocardial infarction or unstable angina is controversial.
We performed a prospective, nonrandomized, observational study of 1,195 consecutive
patients presenting to the ED with chest pain but who had normal or nondiagnostic
electrocardiograms and negative cardiac biomarkers. Patients (mean ± SD age 61 ± 15
years; 55% women) were admitted to the hospital and a standard protocol for evaluation
and treatment was suggested. The use of stress myocardial perfusion imaging (MPI)
or cardiac catheterization during their index hospitalization, and the 3-month incidence
of coronary angiography, percutaneous cardiac intervention, coronary artery bypass
surgery, re-presentation to our institution’s ED for chest pain, myocardial infarction,
or death were followed. Five hundred nine of 1,195 patients (43%) underwent provocative
stress MPI during their index hospitalization; 37% had perfusion defects (predominantly
ischemia). Fifty-six of 1,195 patients (4%) underwent cardiac catheterization without
stress MPI for their primary diagnostic evaluation. Six hundred thirty of 1,195 patients
(53%) had neither MPI or cardiac catheterization during their index hospitalization.
During the 3-month follow-up period, patients with a normal stress perfusion study
during their index hospitalization had fewer return visits (4%) compared with patients
with abnormal perfusion studies (19%), those who underwent catheterization directly
(16%), or patients with no initial diagnostic evaluation (15%) (p <0.001). In addition,
patients who had a diagnostic evaluation during their index hospitalization had a
lower incidence of either acute myocardial infarction (0.9% vs 2.1%) or death (0.4%
vs 3.0%, p <0.001) in the 3-month follow-up period. Accordingly, we strongly advocate
provocative stress MPI early after presentation for chest pain in all patients with
risk factors for coronary artery disease.
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Article Info
Publication History
Accepted:
March 14,
2003
Received in revised form:
March 14,
2003
Received:
January 15,
2003
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
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- Evaluation of patients with chest painAmerican Journal of CardiologyVol. 93Issue 1
