Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram

Alberto Conti, Claudio Poggioni, Gabriele Viviani, Margherita Luzzi, Sonia Vicidomini, Maurizio Zanobetti, Francesca Innocenti, Riccardo Pini, Luigi Padeletti, Gian Franco Gensini

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: The aim of this study is to evaluate incidence of adverse cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram (ECG) and initial troponin. Methods: Prospective, nonrandomized study enrolled low-risk patients with normal ECG and troponin on admission who underwent observation and/or stress testing by unstandardized clinical judgment. Patients who experienced recurrent angina or positive ECGs or positive troponins during observation or patients with positive stress testing were admitted; otherwise, they were discharged. End Point: The end points are cardiac events at short- and long-term follow-up including cardiovascular death, myocardial infarction, unstable angina, and revascularization. Results: Of 5656 patients considered, 1732 with ischemic ECG were initially admitted and, therefore, excluded from the analysis; 2860 with pleuritic chest pain and normal ECG were discharged; 1064 with visceral chest pain and normal ECG were enrolled. Patients with known coronary disease (45%) were older and likely presented known vascular disease. Patients with known vascular disease, older age, female sex, diabetes mellitus, and lower chest pain score were likely managed with observation. In patients with known coronary disease as compared with patients without, overall cardiac events account for 35% vs 14%, respectively (P

Original languageEnglish
Pages (from-to)1698-1705
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume30
Issue number9
DOIs
Publication statusPublished - Nov 2012

ASJC Scopus subject areas

  • Emergency Medicine

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