title: Prognosis of Low-Risk Young Women Presenting to the Emergency Department With Chest Pain.
abstract: Identification of patients at low risk presenting to the emergency department with chest pain is a continuing challenge. We examined a cohort of low-risk women with negative cardiac injury markers, electrocardiogram with normal results, and clinical stability. We hypothesized that these patients can be safely and accurately managed in a chest pain unit (CPU), may not require predischarge cardiac testing, and have an excellent short-term prognosis. The primary end point was major cardiovascular events during index admission or follow-up. Mean age of the 403 women was 42 ± 4.3 years (30 to 50 years). No patient had a cardiovascular event in the CPU, and none of the 321 patients followed for 6 months had a late cardiovascular event. Most (211, 52%) did not receive predischarge cardiac testing. The remaining 192 patients (48%) had predischarge exercise treadmill test, stress imaging, or cardiac catheterization. Of those patients who underwent treadmill testing, almost 90% had no exercise-induced chest pain and approximately 50% had functional capacity 8 to 14 METs. In addition, 166 patients (41%) were discharged from the CPU after <2 hours and 21% (n = 86) within 2 to 8 hours. In conclusion, this group of low-risk women was safely and accurately managed in the CPU and discharged promptly. There were no cardiac events on index admission or 6-month follow-up, and in most patients, predischarge cardiac testing was unnecessary.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California.
authors.forename: Stacey M
authors.initials: SM
authors.lastname: Stauber
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Teleten
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Venugopal
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, California. Electronic address: eaamsterdam@ucdavis.edu.
authors.forename: Ezra A
authors.initials: EA
authors.lastname: Amsterdam
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D002637:Chest Pain / Q000175:diagnosis*; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005080:Exercise Test; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors