Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Clinical Chemistry Score (CCS)
2.3. Outcomes and Statistical Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | CCS < 2 | CCS = 2 | CCS > 2 | Total | p Value |
---|---|---|---|---|---|
N = 6404 | N = 4336 | N = 3936 | N = 14,676 | ||
Demographics | |||||
Age in years, Median (IQR) | 52 (46–60) | 62 (52–71) | 74 (64–82) | 59 (50–71) | <0.001 |
Sex (F) | 3805 (59.4%) | 2396 (55.3%) | 1890 (48.0%) | 8091 (55.1%) | <0.001 |
Past medical history, n (%) | |||||
Arrhythmia | 100 (1.6%) | 221 (5.1%) | 578 (14.7%) | 899 (6.1%) | <0.001 |
Congestive heart failure | 129 (2.0%) | 226 (5.2%) | 841 (21.4%) | 1196 (8.1%) | <0.001 |
Chronic obstructive pulmonary disorder | 753 (11.8%) | 772 (17.8%) | 1042 (26.5%) | 2567 (17.5%) | <0.001 |
Diabetes | 819 (12.8%) | 967 (22.3%) | 1559 (39.6%) | 3345 (22.8%) | <0.001 |
Hypertension | 2308 (36.0%) | 2472 (57.0%) | 3138 (79.7%) | 7918 (54.0%) | <0.001 |
Myocardial infarction | 171 (2.7%) | 209 (4.8%) | 491 (12.5%) | 871 (5.9%) | <0.001 |
Peripheral vascular disease | 70 (1.1%) | 129 (3.0%) | 515 (13.1%) | 714 (4.9%) | <0.001 |
Renal disease | 6 (0.1%) | 15 (0.3%) | 171 (4.3%) | 192 (1.3%) | <0.001 |
Stroke | 35 (0.5%) | 31 (0.7%) | 88 (2.2%) | 154 (1.0%) | <0.001 |
Unstable angina | 79 (1.2%) | 154 (3.6%) | 286 (7.3%) | 519 (3.5%) | <0.001 |
Percutaneous coronary intervention | 190 (3.0%) | 243 (5.6%) | 375 (9.5%) | 808 (5.5%) | <0.001 |
Coronary artery bypass grafting | 28 (0.4%) | 61 (1.4%) | 115 (2.9%) | 204 (1.4%) | <0.001 |
Echocardiography | 2251 (35.1%) | 2043 (47.1%) | 2577 (65.5%) | 6871 (46.8%) | <0.001 |
Cardiac catheterization | 395 (6.2%) | 504 (11.6%) | 819 (20.8%) | 1718 (11.7%) | <0.001 |
Stress testing | 2008 (31.4%) | 1788 (41.2%) | 1822 (46.3%) | 5618 (38.3%) | <0.001 |
Physician follow-up 30 days following ED discharge, n (%) | |||||
Cardiology | 1767 (27.6%) | 1525 (35.2%) | 1598 (40.6%) | 4890 (33.3%) | <0.001 |
General/Family physician | 2358 (36.8%) | 1552 (35.8%) | 1474 (37.4%) | 5384 (36.7%) | |
None | 2279 (35.6%) | 1259 (29.0%) | 864 (22.0%) | 4402 (30.0%) | |
All-cause mortality or hospitalization for MI/UA, n (%) | |||||
30 days | 18 (0.3%) | 37 (0.9%) | 92 (2.3%) | 147 (1.0%) | <0.001 |
90 days | 28 (0.4%) | 48 (1.1%) | 182 (4.6%) | 258 (1.8%) | <0.001 |
365 days | 82 (1.3%) | 146 (3.4%) | 437 (11.1%) | 665 (4.5%) | <0.001 |
Time of Outcome Assessment | Model * | CCS Category | Hazard Ratio (95% CI) |
---|---|---|---|
30 days | 1 | CCS < 2 | 0.33 (0.19–0.58) |
CCS > 2 | 2.76 (1.89–4.05) | ||
2 | CCS < 2 | 0.38 (0.21–0.67) | |
CCS > 2 | 2.31 (1.53–3.47) | ||
3 | CCS < 2 | 0.40 (0.23–0.72) | |
CCS > 2 | 2.05 (1.35–3.13) | ||
90 days | 1 | CCS < 2 | 0.39 (0.25–0.62) |
CCS > 2 | 4.24 (3.09–5.83) | ||
2 | CCS < 2 | 0.49 (0.30–0.79) | |
CCS > 2 | 3.26 (2.35–4.56) | ||
3 | CCS < 2 | 0.51 (0.32–0.82) | |
CCS > 2 | 2.80 (1.98–3.97) | ||
365 days | 1 | CCS < 2 | 0.38 (0.29–0.49) |
CCS > 2 | 3.44 (2.85–4.15) | ||
2 | CCS < 2 | 0.56 (0.43–0.75) | |
CCS > 2 | 2.20 (1.80–2.67) | ||
3 | CCS < 2 | 0.59 (0.45–0.78) | |
CCS > 2 | 1.76 (1.43–2.17) |
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Kavsak, P.A.; Cerasuolo, J.O.; Mondoux, S.E.; Sherbino, J.; Ma, J.; Hoard, B.K.; Perez, R.; Seow, H.; Ko, D.T.; Worster, A. Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department. J. Clin. Med. 2020, 9, 2948. https://doi.org/10.3390/jcm9092948
Kavsak PA, Cerasuolo JO, Mondoux SE, Sherbino J, Ma J, Hoard BK, Perez R, Seow H, Ko DT, Worster A. Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department. Journal of Clinical Medicine. 2020; 9(9):2948. https://doi.org/10.3390/jcm9092948
Chicago/Turabian StyleKavsak, Peter A., Joshua O. Cerasuolo, Shawn E. Mondoux, Jonathan Sherbino, Jinhui Ma, Brock K. Hoard, Richard Perez, Hsien Seow, Dennis T. Ko, and Andrew Worster. 2020. "Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department" Journal of Clinical Medicine 9, no. 9: 2948. https://doi.org/10.3390/jcm9092948