Prospective evaluation of a chest pain pathway at Green Lane Hospital

To prospectively evaluate the efficacy and safety of a chest pain pathway at Green Lane Hospital.

Between August 1999 and March 2000, patients with non-traumatic chest discomfort considered to be possibly ischaemic were assessed by history, physical examination, baseline electrocardiographic findings and point of care troponin T tests. Those considered not to be high risk entered the pathway which included repeat cardiac markers and electrocardiograms at 6-8 hours, followed by optional stress testing. The patients were followed for at least one year.

Of 423 patients with chest discomfort compatible with myocardial ischaemia, 173 were enrolled in the pathway, with 19 later transferred off the pathway for clinical reasons. Of the remaining 154 patients, the median duration of hospital stay was 17.3 hours [IQR 8.2, 25.1] (median of 13.1 hours for those who did not undergo stress testing); 111 (72%) stayed in hospital for less than 24 hours. There were no readmissions within 30 days with an acute coronary syndrome. In the year following discharge, three patients had a myocardial infarction (one of whom later died) and four died of non-cardiac causes. At one year, freedom from cardiac death or non-fatal myocardial infarction was 98% [95%CI 95,100].

The chest pain pathway facilitated patient triage and patients had high event-free survival.