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. 2009 Sep;88(5):307-313.
doi: 10.1097/MD.0b013e3181b98782.

Clinical risk stratification in the emergency department predicts long-term cardiovascular outcomes in a population-based cohort presenting with acute chest pain: primary results of the Olmsted county chest pain study

Michael E Farkouh  1 , Ashish Aneja, Guy S Reeder, Peter A Smars, Sameer Bansilal, Ryan J Lennon, Heather J Wiste, Louai Razzouk, Kay Traverse, David R Holmes Jr, Verghese Mathew
Affiliations

Clinical risk stratification in the emergency department predicts long-term cardiovascular outcomes in a population-based cohort presenting with acute chest pain: primary results of the Olmsted county chest pain study

Michael E Farkouh et al. Medicine (Baltimore). 2009 Sep.

Abstract

The long-term cardiovascular outcomes of a population-based cohort presenting to the emergency department (ED) with chest pain and classified with a clinical risk stratification algorithm are not well documented. The Olmsted County Chest Pain Study is a community-based study that included all consecutive patients presenting with chest pain consistent with unstable angina presenting to all EDs in Olmsted County, Minnesota. Patients were classified according to the Agency for Health Care Policy and Research (AHCPR) criteria. Patients with ST elevation myocardial infarction and chest pain of noncardiac origin were excluded. Main outcome measures were major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days and at a median follow-up of 7.3 years, and mortality through a median of 16.6 years.The 2271 patients were classified as follows: 436 (19.2%) as high risk, 1557 (68.6%) as intermediate risk, and 278 (12.2%) as low risk. Thirty-day MACCE occurred in 11.5% in the high-risk group, 6.2% in the intermediate-risk group, and 2.5% in the low-risk group (p < 0.001). At 7.3 years, significantly more MACCE were recorded in the intermediate-risk (hazard ratio [HR], 1.91; 95% confidence intervals [CI], 1.33-2.75) and high-risk groups (HR, 2.45; 95% CI, 1.67-3.58). Intermediate- and high-risk patients demonstrated a 1.38-fold (95% CI, 0.95-2.01; p = 0.09) and a 1.68-fold (95% CI, 1.13-2.50; p = 0.011) higher mortality, respectively, compared to low-risk patients at 16.6 years. At 7.3 and at 16.6 years of follow-up, biomarkers were not incrementally predictive of cardiovascular risk.In conclusion, a widely applicable rapid clinical algorithm using AHCPR criteria can reliably predict long-term mortality and cardiovascular outcomes. This algorithm, when applied in the ED, affords an excellent opportunity to identify patients who might benefit from a more aggressive cardiovascular risk factor management strategy.

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Figures

Figure 1
Figure 1
Major Adverse Cardiovascular and Cerebrovascular Events at a Median Follow-up of 7.3 Years
Figure 2
Figure 2
Mosaic plot of TIMI and AHCPR
Figure 3
Figure 3
Overall Mortality by AHCPR Risk Level
See this image and copyright information in PMC

References

    1. Abrahamsson P, Rosengren A, Dellborg M. Improved long-term prognosis for patients with unstable coronary syndromes 1988-1995. Eur Heart J. 2000;21:533–539. - PubMed
    1. Allen LA, O'Donnell CJ, Camargo CA, Jr, Giugliano RP, Lloyd-Jones DM. Comparison of long-term mortality across the spectrum of acute coronary syndromes. Am Heart J. 2006;151:1065–1071. - PubMed
    1. Amsterdam EA, Kirk JD, Diercks DB, Lewis WR, Turnipseed SD. Immediate exercise testing to evaluate low-risk patients presenting to the emergency department with chest pain. J Am Coll Cardiol. 2002;40:251–256. - PubMed
    1. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Jr, Chavey WE, 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction. J Am Coll Cardiol. 2007 Aug 14;50(7):e1–e157. Erratum in: J Am Coll Cardiol. 2008 Mar 4;51(9):974. - PubMed
    1. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000 Aug 16;284(7):835–842. - PubMed

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