Chest pain unit (CPU) in the management of low to intermediate risk acute coronary syndrome: a tertiary hospital experience from New Zealand.
BACKGROUND
A chest pain unit (CPU) for management of patients with chest pain at low to intermediate risk for acute coronary syndrome (ACS) appears safe and cost-effective. We report our experience with a CPU from March 2005 to July 2009.


METHODS
Prospective audit of patients presenting with chest pain suggestive of ACS but no high risk features and managed using a CPU, which included; serial cardiac troponins and electrocardiography and exercise tolerance test (ETT) if indicated. Outcomes assessed included three-month readmission rate and one year mortality.


RESULTS
2358 patients were managed according to the CPU. Mean age 56 years (17-96 years), 59% men and median stay of 22h (IQR 17-26h). 1933 (82%) were diagnosed as non-cardiac chest pain. 1741 (74%) patients had an ETT. Median time from triage to ETT was 21h (IQR 16-24h). 64 (2.7%) were readmitted within three months. The majority of readmissions, 39 (61%) were for a non-cardiac cause. Twenty patients (1%) were readmitted with ACS. There was no cardiac death after one year of being discharged as non-cardiac chest pain.


CONCLUSIONS
This study confirms that a CPU with high usage of predischarge ETT is a safe and effective way of excluding ACS in patients without high risk features in a New Zealand setting.
Department of Cardiology, Waikato Hospital, Hamilton, New Zealand. Electronic address: jawadmc2@gmail.com.
J
J
Mazhar
Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
B
B
Killion
Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
M
M
Liang
Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
M
M
Lee
Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
G
G
Devlin
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D020107:Troponin T / Q000097:blood; D055815:Young Adult
D020107:Troponin T