A Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department 30-Days Prospective Study

Abstract

BACKGROUND: Chest pain is a common symptom for referring patients to emergency departments(ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acutecoronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. Thisstudy aimed at investigating 30 days’ adverse outcomes of patients discharged from ED of a major heartcenter in Iran.METHODS: Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age=50.9±15.9 years) who were admitted to Afshar Heart Center’s ED with chest pain as their chiefcomplaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for anyadverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronaryrevascularization (percutaneous angioplasty, coronary artery bypass grafting) and death.RESULTS: Adverse cardiac events, including acute coronary syndrome (ACS), revascularization anddeath were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1(0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI inn=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension,dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischargeadverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previouscoronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and dischargeagainst medical advice (OR=2.85, CI= 1.37-5.91).CONCLUSION: The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiacchest pain within 30 days of discharge was significant, mandating nation-wide registries to provide bettercare for these patients.