Long-term survival of emergency department patients with acute chest pain

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Abstract

To evaluate the long-term prognosis of patients with acute chest pain, prospective clinical data and long-term follow-up data (mean 30.1 ± 9.4 months) were collected for 1,956 patients who presented to the emergency department of an urban teaching hospital with this chief complaint. During follow-up of the 1,915 patients who were discharged alive from the emergency department or hospital, there were 113 (6%) cardiovascular deaths. No differences were detected in the postdischarge cardiovascular survival rates after 3 years of experience with patients who were discharged from the emergency department with a known prior diagnosis of angina or myocardial infarction (89%) and patients who had been admitted and found to have acute myocardial infarction (85%), angina (87%), or other cardiovascular diagnoses (87%). Patients who were discharged from either the hospital or the emergency department without cardiovascular diagnoses had an excellent prognosis. Multivariate Cox regression analysis identified 5 independent correlates of cardiovascular mortality after discharge: age, prior history of coronary disease, ischemic changes on the emergency department electrocardiogram, congestive heart failure and cardlogenic shock. These findings indicate that the postdischarge cardiovascular mortality of patients with chest pain who are discharged from the emergency department with a known history of coronary disease is similar to that of admitted patients with angina or myocardial infarction. These data suggest that the same types of prognostic evaluation strategies that have been developed for admitted patients with ischemic heart disease should also be considered when such patients present to the emergency department but are not admitted.

References (31)

  • J.S. Schroeder et al.

    Do patients in whom myocardial infarction has been ruled out have a better prognosis after hospitalization than those surviving infarction?

    N Engl J Med

    (1980)
  • B. Engby et al.

    The prognosis for patients referred with suspected acute myocardial infarction

    Acta Med Scand

    (1985)
  • L. Goldman et al.

    A computer protocol to predict myocardial infarction in emergency department patients with chest pain

    N Engl J Med

    (1988)
  • T.H. Lee et al.

    Sensitivity of routine clinical criteria for diagnosing myocardial infarction within 24 hours of hospitalization

    Ann Intern Med

    (1987)
  • T.H. Lee et al.

    Candidates for thrombolysis among emergency department patients with acute chest pain: the Multicenter Chest Pain Study Experience

    Ann Intern Med

    (1989)
  • Cited by (0)

    This study was supported in part by grants from the National Center for Health Services Research (HS 05927), the Agency for Health Care Policy and Research (HS-06452), the Robert Wood Johnson Foundation (12543), Princeton, New Jersey, and the John A. Hartford Foundation (83102-2H), New York, New York.

    1

    Dr. Lee is the recipient of Established Investigator Award 900119 from the American Heart Association, Dallas, Texas. Manuscript received July 8, 1991

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