Abstract 3777: High Rates of Recidivism in Patients Presenting to a Chest Pain Unit: Incidence, Patient Profiles and Outcomes in a Total Cohort of Over 3,000 Patients

Abstract

Background: There are minimal data on the magnitude of recidivism and clinical course in patients (pts) with multiple negative evaluations (NE) for acute coronary syndrome (ACS) in a chest pain unit (CPU). Methods: We identified pts with multiple NE in our CPU to determine the incidence, clinical characteristics and ultimate outcomes of this group. Results: During a 7.5 year interval, 3,432 pts were admitted to our CPU of whom 2,249 (66%) had NE. Multiple (≥ 2) NE occurred in 13% (289/2,249) of these pts but they accounted for 26% (696/2656) of total NE. Of the multiple NE pts, 261 (90%) had 2–3 NE and 28 (10%) had ≥ 4 NE (mean 2.7). Characteristics of pts (n=289) with multiple NE: age 52 yr, 54% (156/289) women, 14% (40/289) known coronary artery disease (CAD), 59% (169/289) ≥ 2 risk factors, 65% (188/289) uninsured, 58% (169/289) non-White. During 11.5 yr follow-up, 25% (72/289) of multiple NE pts had a major clinical event (MCE) (2.2%/yr): all-cause mortality 11% (31/289), ACS 8% (24/289), revascularization 10% (28/289), cardiac failure 10% (29/289). Mean time to MCE was 5 yr. MCE was associated with age ≥ 65yrs (47% of 43 pts had MCE), positive insurance (52% of 101), and known CAD (53% of 40 pts) (all p <0.01). Conclusions: Our findings indicate that pts with multiple NE in a CPU accounted for a disproportionate number of all NE one-fourth developed a MCE during longterm follow-up, the majority of which were temporally remote from initial NE, and included 1% annual mortality MCE were associated with older age, known CAD and positive insurance status. NE pts with the latter characteristics may warrant earlier and more aggressive management.