title: Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study.
abstract: BACKGROUND
  Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran.
  
  
  METHODS
  Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death.
  
  
  RESULTS
  Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91).
  
  
  CONCLUSIONS
  The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.
authors: Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors: Mohammadhossien
authors: M
authors: Soltani
authors: Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors: Masoud
authors: M
authors: Mirzaei
authors: Rajaie Cardiovascular, Medical and Research Center, Tehran. Iran.
authors: Ahmad
authors: A
authors: Amin
authors: Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors: Mahmoud
authors: M
authors: Emami
authors: Golestan University of Medical Sciences, Gorgan, Iran.
authors: Reza
authors: R
authors: Aryanpoor
authors: Department of Epidemiology and Biostatistics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors: Farimah
authors: F
authors: Shamsi
authors: Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors: Mohammadtaghi
authors: M
authors: Sarebanhassanabadi
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality; D001026:Coronary Artery Bypass; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D016017:Odds Ratio; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention
keywords: Chest pain; cardiac; discharge; emergency; non-cardiac; outcome