A Prospective Study on Diagnostic Chest Pain Protocol

Hong, Sung Youp; Kim, Gab Teuk; Kang, Meung Hoe

Abstract

PURPOSE
For appropriate triage of chest pain patients in the emergency room (ER), We verified whether or not a new chest pain protocol, which is a combination of Goldman algorithm Cardiac STATus(r) adequately reflects the risk of a major cardiac event in patients with acute chest pain.
METHODS
All patients arriving at the ER were divided into 4 risk group based on the Goldman MI probability and on the result of cardiac STATus(r). one month later, we collected information on whether the patients had undergone major cardiac event or death. We analyzed relative risk (RR) of cardiac event by using a logistic regression and we compare the event-free survival rates and survival lengths. RR=2 mean that the risk of cardiac events is high by two folds than control group.
RESULTS
There were 31 major cardiac events. the relative risk of major events of each group compared to group 4 were 40.1 for group 1, 51.9 for group 2 and 27.4 for group 3. Group 4 patients experienced one cardiac event and no deaths. The survival time without a cardiac event of group 4 patients approach 30 days within experimental error. The survival rate without a cardiac event is 0.98+/-0.02. Therefore, the patients in group 4 had life expectancies similar to those of normal persons.
CONCLUSION
This chest pain protocol adequately reflects the chances of cardiac event, so patients who show a negative result in cardiac STATus(r) and a low Goldman MI probability can be safely discharged from ER and followed up in outpatient clinic.