title: One-stop chest pain clinic can identify high cardiac risk.
abstract: The aim of this study was to record prognosis for patients with stable chest pain referred for outpatient cardiac assessment. All 660 patients in the study had a normal resting ECG and no history of myocardial infarction, unstable angina or coronary revascularisation. Main outcome measures were all-cause mortality, non-fatal ischaemic events and coronary revascularisation. Cardiac chest pain was diagnosed in 182 patients (28%). It was more frequent in patients with recent onset of symptoms (< 6 months), patients over 50, white patients, and patients with hypertension or diabetes. The mean follow-up was 622 +/- 338 days. Among survivors, 37% continued to suffer from symptoms (cardiac group: 59 (35.1%); non-cardiac group: 177 (38.4%)). When all hard events were considered, event-free survival (95% confidence interval) for the cardiac group was 90.9% (86.7-95.2%) at six months, 88.9% (84.2-93.6%) at one year, and 83.6% (77.5-89.7%) at two years. Corresponding figures for the non-cardiac group at the same time points were better (p < 0.0001): 98.5% (97.4-99.6%), 97.5% (96.1-99.0%) and 96.6% (94.7-98.5%), respectively. In conclusion, the use of clinical criteria in a cardiac outpatient clinic, backed up by simple non-invasive investigations, can reliably identify a population at high risk of subsequent cardiac events.
authors.affiliation: Newham General Hospital.
authors.forename: D
authors.initials: D
authors.lastname: Jain
authors.forename: D
authors.initials: D
authors.lastname: Fluck
authors.forename: J W
authors.initials: JW
authors.lastname: Sayer
authors.forename: S
authors.initials: S
authors.lastname: Ray
authors.forename: E A
authors.initials: EA
authors.lastname: Paul
authors.forename: A D
authors.initials: AD
authors.lastname: Timmis
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002423:Cause of Death; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D016001:Confidence Intervals; D003325:Coronary Care Units; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D016017:Odds Ratio; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors; D015996:Survival Rate