The Incremental Diagnostic and Prognostic Value of Contemporary Stress Echocardiography in a Chest Pain Unit: Mortality and Morbidity Outcomes from a Real-World Setting.
Circ Cardiovasc Imaging. 2012 Dec 18;
Authors: Shah BN, Balaji G, Alhajiri A, Ramzy IS, Ahmadvazir S, Senior R
Abstract
BACKGROUND: -Clinical assessment often cannot reliably or rapidly risk-stratify patients hospitalized with suspected acute coronary syndrome (ACS). The "real world" clinical value of stress echocardiography (SE) in these patients is unknown. Thus we undertook this study to assess the feasibility, safety, ability for early triaging and prediction of hard events of SE incorporated into a chest pain unit (CPU) for patients admitted with acute chest pain, non-diagnostic ECG and negative 12 hour troponin. METHODS AND RESULTS: -Accordingly, 839 consecutive patients who underwent clinical, ECG and SE assessments within 24hrs of admission were assessed for feasibility, safety, impact on triaging and discharge, 30-day re-admission rate and were followed-up for hard events (all-cause mortality and acute myocardial infarction [AMI]). Of the 839 patients, 811 (96.7%) had diagnostic SE results. Median time to SE and median length of stay for normal SE patients (77%) were both 1 day. The 30-day re-admission rate was 0.5%. Over long-term follow-up of 27±11 months, 39 hard events (30 deaths & 9 AMI) occurred. Kaplan-Meier estimates of hard events were 0.5% vs. 6.6% in the normal vs. abnormal SE groups respectively in the first year of follow-up (15 events in the first year). Amongst all prognostic variables, only abnormal SE [HR 4.08, 95% CI 2.15-7.72, p <0.001] and advancing age [HR 1.78, 95% CI 1.39-2.37, p< 0.001] predicted hard events in multivariable regression analysis. CONCLUSIONS: -SE incorporated into a CPU has excellent feasibility, provides rapid assessment and discharge with accurate risk stratification of patients with suspected ACS but non-diagnostic ECG and negative 12-hr troponin.
PMID: 23258477 [PubMed - as supplied by publisher]