Usefulness of Predischarge Cardiac Testing in Low Risk Women and Men for Safe, Rapid Discharge from a Chest Pain Unit

Howell, Stacey J.; Prasad, Pooja; Vipparla, Navya; Venugopal, Sandhya; Amsterdam, Ezra A.

doi:10.1016/j.amjcard.2019.02.039

Cited by 8 publications

(8 citation statements)

References 18 publications

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“…Consequently, more men underwent coronary angiography and revascularization than women. These results are not surprising as ASCVD is more prevalent in men and they are also consistent with previous studies in a CPU setting demonstrating a higher rate of angiography and PCI in men as compared with women 8,9,11 . Furthermore, women with chest pain are more likely than men to exhibit nonobstructive CAD upon angiography because of the diverse underlying pathophysiology of ischemia 13 …”

Section: Discussionsupporting

confidence: 88%

“…Although among patients with established coronary artery disease (CAD), the sex differences are well described, 6,7 little is known about the sex differences among patients presenting with ACP, their management, and outcomes. Although several studies demonstrated less noninvasive evaluation in women, other reports did not find sex-related differences in the rate of noninvasive testing during CPU evaluation 8–10 . Apparently, both women and men had a comparable risk of major adverse cardiac event (MACE) during 3–6 months’ follow-up 8,11 .…”

Section: Introductionmentioning

confidence: 96%

“…Although several studies demonstrated less noninvasive evaluation in women, other reports did not find sex-related differences in the rate of noninvasive testing during CPU evaluation. [8][9][10] Apparently, both women and men had a comparable risk of major adverse cardiac event (MACE) during 3-6 months' follow-up. 8,11 Further research based on sex is important to assess the interplay of factors that shape health inequities.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] Apparently, both women and men had a comparable risk of major adverse cardiac event (MACE) during 3-6 months' follow-up. 8,11 Further research based on sex is important to assess the interplay of factors that shape health inequities. The aim of our study was to further analyze possible sex differences among symptomatic patients presenting to the emergency department with ACP and a lowintermediate risk for ACS and evaluated in the CPU.…”

Section: Introductionmentioning

confidence: 99%

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Sex differences of patients with acute chest pain evaluated through a chest pain unit

Arzuan

Iram

Matetzky

et al. 2023

Journal of Cardiovascular Medicine

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BackgroundAlthough sex disparities between patients with acute myocardial infarction are well known, the data regarding sex differences among symptomatic patients with acute chest pain (ACP) are limited.MethodsWe retrospectively evaluated the records of 1000 consecutive patients with ACP and hospitalized in a tertiary medical center chest pain unit (CPU). Patients were divided according to sex. The primary outcome was defined as a composite end point of readmission because of chest pain, incidence of acute coronary syndrome, revascularization, and death at 90 days and 1 year.ResultsOverall, 673 men and 327 women were included in the current analysis. There was no difference in regard to sex for patients who underwent noninvasive evaluation, (87.8 vs. 87.3%, P = 0.85, for female vs. male, respectively). Among patients who underwent coronary computed tomography angiography, women were less likely to have significant coronary artery disease (CAD) (4.2 vs. 11.3%, P = 0.005). Similarly, women had fewer significant findings (4.4 vs. 7.6%, P = 0.007) on myocardial perfusion imaging. Consequently, fewer women underwent angiography (8 vs. 14%, P = 0.006) and revascularization (2.8 vs. 7.3%, P = 0.004). During follow-up, sex was not associated with the development of the primary composite outcome [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.39–2.09, P-value = 0.82 and OR 1.16, 95% CI 0.65–2.06, P-value = 0.59 for 90-day and 1-year follow-up, respectively].ConclusionEvaluation of patients through a CPU enables comparable noninvasive evaluation, appropriate utilization of invasive assessment with similar outcomes during the short and intermediate follow-up period regardless of patients’ sex.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sex differences of patients with acute chest pain evaluated through a chest pain unit

Arzuan

Iram

Matetzky

et al. 2023

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…85,86 Routine use of pre-discharge ischaemia testing may, however, lead to a longer length of stay in the ED or observation units, more downstream invasive angiography and revascularisation procedures, more radiation exposure and greater costs without any improvement in clinical outcome. [87][88][89][90] Use of the HEART score may aid in identifying the patients in whom predischarge testing should be considered. 30,31 In the HEART pathway implementation trial, patients with a HEART score of 3 or less in whom an ACS was excluded by serial troponin testing could be safely discharged without further testing.…”

Section: Further Predischarge Testingmentioning

confidence: 99%