Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department.
OBJECTIVE
This study is an audit of the risk stratification of patients admitted to a university hospital emergency department with a suspected acute coronary syndrome (ACS). The main aim of the study was to investigate the prognosis of those patients who were discharged to home from the emergency room (ER) or adjacent chest pain observation unit (CPU).


RESULTS
Three thousand one hundred and seven consecutive patients admitted to the ER with a suspected ACS were retrospectively identified. Seven hundred and sixty-four (25%) patients were discharged from the ER and 417 (13%) from the CPU after observation and ruling out myocardial infarction (MI) and high-risk ACS. One thousand seven hundred and two patients were hospitalized. Follow-up end-points were cardiovascular mortality, hospitalization for ACS and incidence of any cardiovascular disease event during 6 months. During 4 weeks after the discharge from the ER and CPU cardiovascular mortality was 0.1% and 0.5% and during 6 months 0.8% and 1.7%, respectively. Within 6 months 4.2% and 8.4% of the patients were hospitalized for ACS and 9.3% and 11.5% had a cardiovascular disease event.


CONCLUSIONS
Patients admitted with chest pain may be safely discharged from the emergency department, if there is no evidence of MI or high-risk ACS. However, further examination and appropriate treatment must be arranged.
Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
Heli
H
Koukkunen
Kalevi
K
Pyörälä
Matti
M
O  Halinen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014218:Triage