Clinical features and prognosis of patients with acute non-specific chest pain in emergency and cardiology departments after the introduction of high-sensitivity troponins: a prospective cohort study

Abstract

ObjectivesTo determine the incidence of clinical, cardiac-related endpoints and mortality among patients presenting to an emergency or cardiology department with non-specific chest pain (NSCP), and who receive testing with a high-sensitivity troponin. A second objective was to identify risk factors for the above-noted endpoints during 12 months of follow-up.DesignA prospective multicentre study.SettingEmergency and cardiology departments in Southern Denmark.SubjectsThe study enrolled 1027 patients who were assessed for acute chest pain in an emergency or cardiology department, and in whom a myocardial infarction or another obvious reason for chest pain had been ruled out. Patients were enrolled from September 2014 to June 2015 and followed for 1 year.Main outcome measuresClinical, cardiac-related endpoints (cardiac-related death, acute myocardial infarction, unstable angina and coronary revascularisation) and all-cause mortality.ResultsOver a period of 1 year, cardiac-related endpoints were found in 19 patients (1.9%): 0 patients experienced cardiac-related death, 2 (0.2%) had myocardial infarction, 4 (0.4%) had unstable angina pectoris and 17 (1.7%) underwent coronary revascularisation. All-cause mortality was observed in seven patients (0.7%). When compared with the general population, the standardised mortality ratio did not differ. The risk factors associated with the study endpoints included male gender, body mass index >25 kg/m2, previous known coronary artery disease, hypertension, hypercholesterolaemia, diabetes mellitus and the use of statins. A total of 73% of the endpoints occurred in males.ConclusionThe prognosis for patients with NSCP is favourable, with a 1-year mortality after discharge that is comparable with the background population. Few clinical endpoints took place during follow-up, and those that did were predominantly in males.

Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department

“…3,4 ''Oligoanalgesia'' refers to the underuse of analgesics and studies indicated that a large portion of patients are discharged in moderate to severe pain. [5][6][7][8] There is a need for simple, effective, and opioid minimizing interventions to improve ED pain management.…”

Clinical implications of high‐sensitivity cardiac troponins

“…The prevalence of MI in patients who undergo troponin testing in the ED is strongly dependent on how patients are selected; testing without or with little selection of patients will result in low prevalence of MI, whilst a more conservative approach where only patients with a high likelihood of MI are selected will lead to a higher prevalence . Although chest pain infrequently may be associated with other acute conditions that need prompt treatment, such as pulmonary embolism or aortic dissection, in the vast majority of cases chest pain is associated with benign conditions with an excellent short‐ and long‐term prognosis . Therefore, rapid rule‐out of MI in patients with chest pain is crucial to avoid costs associated with unnecessary investigations and hospital stays .…”