Risk stratification of patients with acute chest pain without a rise in troponin: current practice in England

BACKGROUND: Patients presenting with acute chest pain without a rise in cardiac troponins are considered to be at low risk of adverse cardiac events and are often considered for early discharge without further inpatient investigation. However, there is evidence that this commonly encountered patient group has a significant rate of early acute myocardial infarction and death. OBJECTIVE: To assess current practice in the risk stratification of patients presenting with acute chest pain to emergency departments (EDs) in England who do not develop a rise in cardiac markers. METHODS: A postal survey was sent to all 193 EDs. This contained 21 questions related to the assessment of patients presenting with acute chest pain. RESULTS: 141 EDs returned completed questionnaires. 27% of responding departments routinely used objective clinical risk scoring as part of their risk stratification. Less than 16% carried out exercise stress testing on the majority of patients prior to discharge from hospital. CONCLUSIONS: The use of troponin as a diagnostic test and risk stratification tool appears to be used universally in England. However, the further risk stratification of patients presenting with acute chest pain without a rise in cardiac troponin is inconsistent.