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Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments
Frank M Sanfilippo1, Graham S Hillis2,3, Jamie M Rankin4
1School of Population and Global Health, The University of Western Australia, Perth 6009, Australia.
Insights
Men presenting with chest pain to emergency departments (EDs) are twice as likely to undergo invasive coronary angiography (ICA) compared to women. This occurs despite similar presentation rates and highlights potential gender disparities in cardiac care pathways.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Chest pain is a common presentation to emergency departments (EDs).
- Invasive coronary angiography (ICA) is a key diagnostic tool for acute coronary syndromes.
- Factors influencing ICA utilization in ED chest pain patients require investigation.
Purpose of the Study:
- To identify factors influencing the use of invasive coronary angiography (ICA) in patients presenting to emergency departments (EDs) with chest pain.
- To examine gender differences in ICA utilization.
- To assess the diagnostic context of ICA, including troponin testing.
Main Methods:
- Retrospective cohort study using linked ED, hospitalization, death, and cardiac biomarker data.
- Inclusion of patients aged 20+ presenting with chest pain to tertiary public hospital EDs in Western Australia (Jan 2016 - Mar 2017).
- Analysis included patient characteristics, diagnoses, pathways to ICA, troponin results, and gender differences using Pearson Chi-squared test and logistic regression.
Main Results:
- 16,974 patients (20,131 presentations) with a mean age of 55.6 years (50.7% male).
- Acute coronary syndrome diagnosed in 10.4% of presentations.
- 9.1% of presentations underwent ICA within 90 days; men (12.3%) were twice as likely as women (6.1%) to receive ICA (adjusted OR 1.89).
- 36.6% of ICAs were performed with normal troponin levels.
Conclusions:
- Despite equal presentation rates of chest pain, men are significantly more likely to undergo invasive coronary angiography than women.
- A substantial proportion of ICAs are performed in patients with normal troponin levels, suggesting a need to refine risk stratification and evaluate cost-effectiveness.
- Further research is needed to understand the risk profiles and outcomes associated with ICA in patients with normal troponin levels.
Abstract:
We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.
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