One-stop chest pain clinic can identify high cardiac risk

Area of Science:

• Cardiology
• Clinical Medicine
• Public Health

Background:

• Stable chest pain is a common reason for outpatient cardiac assessment.
• Prognosis and risk stratification are crucial for managing patients with chest pain.

Purpose of the Study:

• To determine the prognosis of patients with stable chest pain undergoing outpatient cardiac assessment.
• To identify factors associated with cardiac chest pain and subsequent cardiac events.

Main Methods:

• A cohort of 660 patients with stable chest pain, normal resting ECG, and no prior cardiac events were followed.
• Data collected included all-cause mortality, non-fatal ischemic events, and coronary revascularization.
• Clinical criteria were used to diagnose cardiac chest pain.

Main Results:

• Cardiac chest pain was diagnosed in 28% of patients, more common in those with recent symptoms, over 50 years old, white, or with hypertension/diabetes.
• Event-free survival at two years was 83.6% for the cardiac group versus 96.6% for the non-cardiac group (p < 0.0001).
• 37% of survivors experienced persistent symptoms, with similar rates in both cardiac and non-cardiac groups.

Conclusions:

• Outpatient cardiac assessment using clinical criteria and non-invasive tests reliably identifies patients at high risk for cardiac events.
• While overall prognosis is good, a substantial proportion of patients experience ongoing symptoms.
• Risk stratification is essential for appropriate management of stable chest pain patients.