Background: An accelerated diagnostic protocol (ADP) for evaluating patients with acute chest pain using a chest pain unit (CPU) has shown its safety and cost-effectiveness. Nevertheless, elderly patients are often excluded from such a rapid evaluation due to fear from adverse events and poorer outcome.
Objective: To assess the feasibility and safety of evaluation of patients ≥ 65 years old presenting with ACP using an ADP using contemporary noninvasive imaging modalities.
Methods: We evaluated 1,068 consecutive patients who were admitted to our CPU and underwent evaluation using either multi-detector computed tomography (MDCT) or myocardial perfusion imaging (MPI).Patients were evaluated for in hospital outcomes and 90 days MACE consistent of recurrent hospitalization due to chest pain, PCI, re-ACS, and death.
Results: Overall, 180 patients comprised the group ≥65 years old. Patients ≥65 were significantly more likely to be female, have more co-morbidity and have a history of ACS. There was no difference between the 2 groups during the observation period in the CPU in regard to recurrent chest pain, abnormal ECG findings, and troponin elevation. Patients ≥65 years old underwent significantly more MPI tests (67% vs. 39%,p
Conclusion: Evaluation of elderly patient s through a CPU is feasible with comparable in hospital outcomes to younger individuals. While elderly patients should not be excluded from being evaluated through a CPU, these patients suffer a higher event rate during follow-up.
