Background: An accelerated diagnostic protocol of evaluating low risk patients with Acute Chest Pain (ACP) in cardiologist-based Chest Pain Unit (CPU) has shown its safety and cost-effectiveness and is widely employed today. However, there is limited data regarding the safety of applying such a protocol for patients with known prior coronary artery disease (CAD).
Objective: To assess the safety of using an accelerated diagnostic protocol in patient presenting with ACP with a history of CAD through a cardiologist-based CPU.
Methods: We evaluated 623 consecutive patients who presented with ACP, were hospitalized in our CPU, and underwent evaluation using an accelerated diagnostic algorithm. Patients were stratified according to whether they had a history of priory CAD or not. Primary composite outcome was defined as a composite of readmission due to chest pain, re-acute coronary syndrome, percutaneous intervention or bypass graft, or death during a 30 and a 90-day follow up period.
Results: Overall, 205 patients had a history of known CAD. Patients with prior CAD were older, more likely to be men, have hypertension, dyslipidemia, and a family history of CAD when compared to those without known CAD. During the evaluation period 59 patients (9.5%) were hospitalized for further investigation with 26 (4.2%) undergoing revascularization, without significant difference between the two study groups. During a 30-and 90-day follow up period the primary endpoint occurred in 8 and 18 patients, without significant difference between the 2 groups with no mortalities recorded.
Conclusion: Evaluation of patients with known CAD using an accelerated diagnostic algorithm is safe and should not exclude patients from being evaluated through a CPU.
