One-stop chest pain clinic can identify high cardiac risk

Abstract

The aim of this study was to record prognosis for patients with stable chest pain referred for outpatient cardiac assessment. All 660 patients in the study had a normal resting ECG and no history of myocardial infarction, unstable angina or coronary revascularisation. Main outcome measures were all-cause mortality, non-fatal ischaemic events and coronary revascularisation. Cardiac chest pain was diagnosed in 182 patients (28%). It was more frequent in patients with recent onset of symptoms (< 6 months), patients over 50, white patients, and patients with hypertension or diabetes. The mean follow-up was 622 +/- 338 days. Among survivors, 37% continued to suffer from symptoms (cardiac group: 59 (35.1%); non-cardiac group: 177 (38.4%)). When all hard events were considered, event-free survival (95% confidence interval) for the cardiac group was 90.9% (86.7-95.2%) at six months, 88.9% (84.2-93.6%) at one year, and 83.6% (77.5-89.7%) at two years. Corresponding figures for the non-cardiac group at the same time points were better (p < 0.0001): 98.5% (97.4-99.6%), 97.5% (96.1-99.0%) and 96.6% (94.7-98.5%), respectively. In conclusion, the use of clinical criteria in a cardiac outpatient clinic, backed up by simple non-invasive investigations, can reliably identify a population at high risk of subsequent cardiac events.