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European Heart Journal 2004 25(4):329-334; doi:10.1016/j.ehj.2003.12.005
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

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

Heli Koukkunena,*, Kalevi Pyöräläa and Matti O. Halinenb

a Department of Medicine, Kuopio University Hospital, Kuopio, Finland
b Accident and Emergency Department, Kuopio University Hospital, Kuopio, Finland

* Correspondence to: Dr H. Koukkunen, Kuopio University Hospital, Department of Medicine, PO Box 1777, FIN-70211 Kuopio, Finland. Tel: +358 17 173 311; Fax: +358 17 172 543

Received 28 April 2003; revised 27 November 2003; accepted 4 December 2003

Abstract

Aims This study is an audit of the risk stratification of patients admitted to a university hospital emergency department with a suspected acute coronary syndrome (ACS). The main aim of the study was to investigate the prognosis of those patients who were discharged to home from the emergency room (ER) or adjacent chest pain observation unit (CPU).

Methods and results Three thousand one hundred and seven consecutive patients admitted to the ER with a suspected ACS were retrospectively identified. Seven hundred and sixty-four (25%) patients were discharged from the ER and 417 (13%) from the CPU after observation and ruling out myocardial infarction (MI) and high-risk ACS. One thousand seven hundred and two patients were hospitalized. Follow-up end-points were cardiovascular mortality, hospitalization for ACS and incidence of any cardiovascular disease event during 6 months. During 4 weeks after the discharge from the ER and CPU cardiovascular mortality was 0.1% and 0.5% and during 6 months 0.8% and 1.7%, respectively. Within 6 months 4.2% and 8.4% of the patients were hospitalized for ACS and 9.3% and 11.5% had a cardiovascular disease event.

Conclusions Patients admitted with chest pain may be safely discharged from the emergency department, if there is no evidence of MI or high-risk ACS. However, further examination and appropriate treatment must be arranged.

Key Words: Acute coronary syndrome • Myocardial infarction • Prognosis • Emergency room • Chest pain observation unit


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