A033 Management and Outcomes of Patients Presenting With “Not Low Risk” EDACS Chest Pain, With Negative or Static Troponins

Abstract

Emergency Department (ED) Assessment of Chest pain Score (EDACS) identifies patients with chest pain who are at low risk of major adverse cardiac event (MACE) and safe to be discharged from ED. However, the management and outcomes of “not low risk” EDACS patients who have negative or static troponins, are unclear. We retrospectively reviewed 100 consecutive patients referred by ED from January 2018 to February 2018 with “not low risk” EDACS chest pain who had negative or static troponins. Of 100 patients, 37 were discharged from ED and 63 were admitted. Twenty-one patients underwent non-invasive testing, and 23 patients underwent coronary angiograms (five had normal coronary arteries (22%), six had coronary artery disease (CAD) for medical management (26%), 12 required revascularisation (52%)). Twenty-five patients were diagnosed with cardiac chest pain (CCP), 15 with possible cardiac chest pain (PCCP), and 60 with non-cardiac chest pain (NCCP). At two years, nine out of 25 CCP patients (36%) re-presented with cardiac chest pain, compared to three out of 15 PCCP patients (20%), and five out of 60 NCCP patients (8%). At 30 days, one patient (NCCP group) had MACE (type II myocardial infarction, who had no flow-limiting disease on angiogram). There is a significant burden of CAD in this patient group, however, the overall MACE at 30 days remains low. The current workup largely differentiates non-cardiac and cardiac chest pain, evidenced by the lower rates of re-presentation in the NCCP group with cardiac chest pain.