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Feasibility and safety of evaluating patients with prior coronary artery disease using an accelerated diagnostic algorithm via a chest pain unit

Session Poster Session 5

Speaker Alexander Fardman

Event : Acute Cardiovascular Care 2016

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
  • Session type : Poster Session

Authors : A Fardman (Tel Hashomer,IL), R Beigel (Tel Hashomer,IL), R Goldkorn (Tel Hashomer,IL), O Goitein (Tel Hashomer,IL), S Ben-Zekery (Tel Hashomer,IL), M Narodetsky (Tel Hashomer,IL), M Livne (Tel Hashomer,IL), A Sabbag (Tel Hashomer,IL), E Asher (Tel Hashomer,IL), S Matetzky (Tel Hashomer,IL)

Authors:
A Fardman1 , R Beigel1 , R Goldkorn1 , O Goitein1 , S Ben-Zekery1 , M Narodetsky1 , M Livne1 , A Sabbag1 , E Asher1 , S Matetzky1 , 1Chaim Sheba Medical Center - Tel Hashomer - Israel ,

On behalf: PLATIS

Citation:
European Heart Journal Supplement ( 2010 ) 12 ( Supplement F ), F396

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 a history of prior coronary artery disease (CAD).
Purpose: To assess the feasibility and safety of evaluating patients with a history of prior CAD via a CPU.
Methods: We evaluated 1,220 consecutive patients who presented with ACP, hospitalized in our CPU, and underwent evaluation using an accelerated diagnostic algorithm. Patients were stratified according to whether they had a history of prior CAD or not. The Primary outcome was defined as a composite of readmission due to chest pain, acute coronary syndrome, revascularization, or death during a 60 day follow up period.
Results: Overall, 268 (22%) patients had a history of prior CAD. Patients with a history of prior CAD were older, more likely to be male, and to suffer from hypertension, diabetes mellitus, dyslipidemia, peripheral vascular disease, and have had a prior stroke when compared to those without prior CAD. Non-invasive evaluation was performed in 1,112 (91%) patients. The two study groups were similar regarding hospitalization rates, coronary angiography, and revascularization performed during CPU evaluation. During a 60-day follow up period the primary endpoint occurred in 12 (1.6%) and 6 (3.2%) patients without and with a history of prior CAD respectively (p value = 0.836) with no mortalities recorded.
Conclusion: Patients with a history of prior CAD can be safely and expeditiously evaluated using an accelerated diagnostic protocol via a CPU with outcomes not differing from those without such a history.

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