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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 October;164(5):363-6
Chest pain emergency management in patients at low risk for coronary syndrome
Bartoli M. 1, Colombo G. M. 2, Marino G. 2, Monaco G. 2, Ghilardi P. 3, Cicchinelli M. 2
1 Dipartimento Cardiovascolare, Attività Ambulatoriale di I livello, Azienda Ospedaliera S. Camillo Forlanini, Roma;
2 Dipartimento di Emergenza-Accettazione, U.O. Medicina d’Urgenza e Pronto Soccorso, Azienda Ospedaliera S. Camillo Forlanini, Roma;
3 Dipartimento Cardiovascolare, U.O. Studio Flusso Coronarico, Azienda Ospedaliera S. Camillo Forlanini, Roma
Aim. Chest pain is one of the most frequent conditions in patients presenting to the Emergency Department (ED). In our research we have tried a new kind of management of patients at low risk for coronary syndrome, admitted in our Emergency Medicine Unit (EMU).
Methods. Between October 2002 and October 2003 we have observed 144 patients (95 males and 49 females, mean age 62.9 years, range 32-84). This population included 33 patients with previous hystory of coronary artery disease (CAD), defined as previous treatement with percutaneous transluminal coronary angioplasty (PTCA), or ptca and stent positioning, or coronary artery bypass graft surgery (CABG). The hospital stay was 1.9 days (range 1-3) and during this period all patients had a first physician staging and after were discharged with a program of further controls as outpatients.
Results. In our study 93 (64.5%) were evaluated with myocardial stress (exercise or pharmacologic) scintigraphy, by single photon emission computed tomography (SPECT; group A), 48 (33.3%) with exercise treadmill testing (group B) and 3 (2.2%) with stress (dobutamine) echocardiography (group C). The positive rate of stress tests was 25.6% (37/144; 84.6% males and 13.6 % females): 27 of group A (29%) had positive test with SPECT, 9 of group B (18.7%) positive with treadmill excercise and 1 of group C (33.3%) positive with dobutamine echostress. In CAD population this rate was 39.3% (13/33), compared with 21.6% (24/111) in those without previous CAD.
Conclusions. Follow-up data revealed a morbidity of 0.6% (1/144, without previous CAD) for cardiovascular events (the patient required hospitalization because of non ST elevation miocardial infarction) and no mortality at 60 days. Clinical course in the patients with positive test was uncomplicated at 60 days.