Effectiveness of a multidisciplinary chest pain unit for the assessment of coronary syndromes and risk stratification in the Florence area

Conti, Alberto; Paladini, Barbara; Toccafondi, Simone; Magazzini, Simone; Olivotto, Iacopo; Galassi, F.; Pieroni, Cesco; Santoro, Gennaro; Antoniucci, David; Bèrni, G

doi:10.1067/mhj.2002.124352

Cited by 12 publications

(7 citation statements)

References 33 publications

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“…In Conti et al 's study [11] consecutive patients with chest pain admitted to the ED were screened. Based upon a validated chest pain score patients with intermediate and high-risk were categorized as 'ACS/high-risk'.…”

Section: Resultsmentioning

confidence: 99%

“…In the NSCP group, the mean one-year mortality rate in nine studies was 3.2% (range 1.4 to 8.1%), excluding the study of Conti et al [11] which had a six month cardiac mortality rate of 0% and the study of Bholasingh et al [8] in which cardiac, not total, mortality was reported. Only one study reported the mortality rate for NSCP patients both with and without concomitant CHD, this being 8.4% and 1.5%, respectively [17].…”

Section: Resultsmentioning

confidence: 99%

“…One study reported a six month mortally rate of 10.6% for patients with AMI and 1.1% with UAP [11]. None of the selected studies provided readmission rates for the 'ACS/high risk' group.…”

Section: Resultsmentioning

confidence: 99%

“…This implies that white men, but indeed all patient categories, presenting with chest pain in general should be considered both for careful cardiac and non-cardiac assessments. Based upon the academic literature, many patients with NSCP may potentially profit from management of psychiatric, gastrointestinal or musculoskeletal disorders [7,11,13,18,24-27]. Although not apparent from studies exploring the etiology of NSCP, it seems reasonable that several patients may represent combinations of these disorders, with need for various interventions.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome - a systematic literature search

Ruddox

Mathisen

Otterstad

2012

BMC Med

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BackgroundThe term non-specific chest pain (NSCP) is applied to hospitalized patients in order to designate that they neither have an acute coronary syndrome (ACS) nor display evidence of a coronary ischemia. The number of NSCP patients is increasing and comprehensive guidelines specifying their optimal management have not yet been introduced. The objective of this review was to explore the prevalence and prognosis of NSCP versus ACS among patients recruited in consecutive series hospitalized for chest pain suspected to be ACS.MethodsThis is a systematic literature search where three databases were searched from 1990 to 14 November 2011. In addition, one database was searched for Epub ahead of print per 24 March 2012. Three inclusion criteria were applied: 1. documentation of an unselected consecutive series of patients admitted for chest pain, where this review is based upon two groups of patients defined as follows: a) 'ACS/high-risk' and b) NSCP; 2. at least 100 cases with NSCP; and 3. follow-up of hospital readmissions and mortality for at least six months.ResultsA total of 2,204 citations were screened after removal of duplicates. Out of 80 full text articles assessed for eligibility 12 studies were included, comprising 24,829 patients (inter-study range 250 to 13,762), with 11,008 (44%) categorized as NSCP and 13,821 (56%) as 'ACS/high-risk'. The mean one-year total mortality rate among patients with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with the highest mortality among patients with pre-existing coronary heart disease (CHD). The mean one-year mortality rate among 'ACS/high-risk' patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with available data. In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%).ConclusionsPatients with NSCP represent a large, heterogeneous and important group. Due to co-existing CHD in nearly 40% of these patients, their prognosis is not necessarily benign. Although their average one-year mortality rate was almost six times lower than those with 'ACS/high-risk', the subset with concomitant CHD had a relatively poor prognosis when compared with NSCP patients without evidence of CHD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…One study reported a six month mortally rate of 10.6% for patients with AMI and 1.1% with UAP [11]. None of the selected studies provided readmission rates for the 'ACS/high risk' group.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome - a systematic literature search

Ruddox

Mathisen

Otterstad

2012

BMC Med

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“…Amongst the latter, acute coronary syndrome [ACS, defined as a spectrum of disease ranging from unstable angina (UA) to MI], pulmonary embolism, aortic dissection, tension pneumothorax, pericardial tamponade, and esophageal rupture are the bogeymans of the emergency physicians (EPs), that have the constant concern and duty to rule out potentially life-threatening causes and to act a diagnostic and management strategy allowing a rapid and safe disposition of patients. ACS, however, only accounts for 20-25% of chest pain patients visited in ED (11), and only for 45% of patients admitted to a Chest Pain Unit (12).…”

Section: Overview On Chest Painmentioning

confidence: 99%

The clinics of acute coronary syndrome

Cervellin¹,

Rastelli²

2016

Annals of Translational Medicine

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Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt.

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Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department

Koukkunen¹

2004

European Heart Journal

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Effectiveness of a multidisciplinary chest pain unit for the assessment of coronary syndromes and risk stratification in the Florence area

Cited by 12 publications

References 33 publications

Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome - a systematic literature search

Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome - a systematic literature search

The clinics of acute coronary syndrome

Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department

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