Risk for Clinically Relevant Adverse Cardiac Events in Patients With Chest Pain at Hospital Admission.
Michael B Weinstock1, Scott Weingart2, Frank Orth3
1Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, Columbus2Department of Emergency Medicine, Mount Carmel St. Ann's, Westerville, Ohio.
JAMA Internal Medicine
|May 19, 2015
Summary
Short-term adverse cardiac events are rare in chest pain patients with negative troponin and normal ECGs. Most events in this low-risk group were non-cardiac or iatrogenic, questioning routine hospital admission.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Outcomes Research
Background:
- Patients presenting with chest pain often undergo hospital admission or observation due to concerns for adverse cardiac events.
- Previous research has focused on 30-day mortality, but short-term risks for clinically relevant adverse cardiac events remain less understood for emergency department (ED) dispositions.
Observation:
- A prospective database review analyzed 45,416 adult patient encounters with chest pain symptoms and negative serial biomarkers.
- The study included 11,230 patients with negative troponin, normal vital signs, and non-ischemic ECG findings.
Findings:
- The incidence of major adverse cardiac events (life-threatening arrhythmia, myocardial infarction, arrest, or death) was low at 0.18% in the overall cohort.
- In a subgroup with normal vital signs and ECGs, the event rate further decreased to 0.06%, with events often being non-cardiac or iatrogenic.
Implications:
- Routine inpatient admission for chest pain patients with negative biomarkers and normal initial evaluations may not be a beneficial strategy.
- These findings suggest a potential for improved ED disposition strategies, reducing unnecessary hospitalizations and associated healthcare costs.
- Further research could refine risk stratification tools for chest pain presentations in the ED.
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