Evaluation of Patients with History of Prior Coronary Artery Disease Using Accelerated Algorithm in Chest Pain Unit (PLATIS-1)

Roy Beigel 1,2 Alex Fardman 1,2 Nir Shlomo 1,2 Moran Livne 1,2 Avi Sabbag 1,2 Elad Maor 1,2 Orly Goitein 1,2 Ronen Goldkorn 1,2 Elad Asher 1,2 Shlomi Matetzky 1,2
1Leviev Heat Institute, Sheba Medical Center, Tel Hashomer, Israel
2The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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.









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