Key result
Patients with non-cardiac chest pain had a significantly lower 1-year all-cause mortality rate (2.3% vs 7.2%) and MACE occurrence (5.1% vs 8.3%) compared to those with cardiac chest pain.
Why the study?
Does a diagnosis of non-cardiac chest pain compared to cardiac chest pain affect prognosis and healthcare utilization in patients presenting to the emergency department?
Cohort (n=1,239)
No
Does a diagnosis of non-cardiac chest pain compared to cardiac chest pain affect prognosis and healthcare utilization in patients presenting to the emergency department?
Absolute Event Rate: 2.3% vs 7.2%
p-value: p=<0.001
Patients discharged with non-cardiac chest pain have lower 1-year mortality and MACE than those with cardiac chest pain, but still experience a 5.1% MACE rate and utilize substantial healthcare resources, particularly if they have a history of coronary artery disease.
Objective: Presentations of non-cardiac chest pain (NCCP) to the emergency department (ED) are increasing. More knowledge of prognosis and healthcare utilisation of patients with NCCP is necessary to optimise their management. Methods: This study is a prospective, observational, prevalence-based cohort study conducted from September 2015 to February 2016 with 1-year follow-up including all patients 18 years and older referred to the ED with chest pain. Discharge diagnoses, mortality, major adverse cardiac events (MACE), re-presentations to the ED, hospitalisations, cardiac interventions and outpatient monitoring were assessed. Results: More than 60% of the 1239 patients presenting with chest pain were discharged with NCCP. The all-cause 1-year mortality rate of patients with NCCP was 2.3% compared with 7.2% in patients with cardiac chest pain (CCP) (p<0.001) and the occurrence of MACE was 5.1% vs 8.3%, respectively (p=0.026). Previous history of coronary artery disease (CAD) in patients with NCCP was identified as a predictive factor for MACE (OR 4.30 (95% CI 1.24 to 14.89), p=0.021). Patients with NCCP had more non-invasive interventions than patients with CCP (proportion of 0.225 vs 0.165 per patient, p<0.001) and 13.7% of patients with NCCP re-presented at the ED within 1 year. Conclusion: The majority of patients referred to the ED with chest pain are discharged with NCCP. The prognosis of patients with NCCP is better than patients with CCP; however, they are at risk for MACE due to a history of CAD. Patients with NCCP moreover use a substantial amount of medical resources, stressing the importance of good triage to minimise unnecessary healthcare utilisation while still preventing MACE.
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Mol et al. (2018) conducted a cohort in Chest pain (suspected acute coronary syndrome) (n=1,239). Non-cardiac chest pain vs. Cardiac chest pain was evaluated on All-cause 1-year mortality (p=<0.001). Patients with non-cardiac chest pain had a significantly lower 1-year all-cause mortality rate (2.3% vs 7.2%) and MACE occurrence (5.1% vs 8.3%) compared to those with cardiac chest pain.
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