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Short-term risk after initial observation for chest pain.
Christopher Lai1, Thomas P Noeller, Kristen Schmidt
1Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
The Journal of Emergency Medicine
|December 5, 2003
Summary
Discharging chest pain unit patients before stress testing is safe. This study found a low rate of short-term adverse cardiac events, supporting outpatient stress testing for selected patients.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Immediate stress testing after chest pain observation is debated.
- Assessing the safety of outpatient stress testing post-discharge is crucial.
Purpose of the Study:
- To evaluate the safety of outpatient stress testing after chest pain unit discharge.
- To determine if early discharge before stress testing is associated with adverse outcomes.
Main Methods:
- Retrospective chart review of patients discharged from a chest pain unit before stress testing.
- Analysis of adverse cardiac outcomes up to 60 days post-discharge.
- Primary outcomes: death or myocardial infarction; Secondary outcomes: readmission for chest pain, unstable angina, congestive heart failure.
Main Results:
- 0.6% of patients experienced fatal out-of-hospital cardiac events.
- 7.0% had subsequent emergency department visits for chest pain.
- 2.6% were admitted to the hospital and 2.9% readmitted for chest pain.
Conclusions:
- Patients with negative serial ECGs and enzyme tests in chest pain units have low short-term cardiac event risk.
- Selected patients can be safely discharged for outpatient stress testing.
- Outpatient stress testing is a viable strategy for selected chest pain unit patients.