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

BMC Medicine

Jan Erik Otterstad²  Mariann Mathisen¹  Vidar Ruddox² 

[1] Medical Libraries, Vestfold Hospital Trust, Tønsberg, Norway;Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway

关键词: mortality;    readmissions;    prognosis;    acute coronary syndrome;    chest pain not yet diagnosed;    atypical chest pain;    non-cardiac chest pain;    non-specific chest pain;    Hospitalizations;   

Others  :  1126125
DOI  :  10.1186/1741-7015-10-58

 received in 2011-12-30, accepted in 2012-06-12,  发布年份 2012

【 摘 要 】

Background

The 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.

Methods

This 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.

Results

A 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%).

Conclusions

Patients 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.

【 授权许可】

   
2012 Ruddox et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Van Handel D, Fass R: The pathophysiology of non-cardiac chest pain. J Gastroenterol Hepatol 2005, (20 Suppl):S6-13.
• [2]Eslick GD: Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life. Gastroenterol Clin North Am 2004, 33:1-23.
• [3]Eslick GD: Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Dis Mon 2008, 54:604-612.
• [4]Kisely SR: The relationship between admission to hospital with chest pain and psychiatric disorder. Aust N Z J Psychiatry 1998, 32:172-179.
• [5]Syed N, Congdon P: Frequent hospital admissions. Public Health Report No:DPH 214. London; 2007.
• [6]Nasrallah N, Steiner H, Hasin Y: The challenge of chest pain in the emergency room: now and the future. Eur Heart J 2011, 32:656.
• [7]Panju A, Farkouh ME, Sackett DL, Waterfall W, Hunt R, Fallen E, Somers S, Stevenson G, Walter S: Outcome of patients discharged from a coronary care unit with a diagnosis of "chest pain not yet diagnosed". CMAJ 1996, 155:541-546.
• [8]Bholasingh R, de Winter RJ, Fischer JC, Koster RW, Peters RJ, Sanders GT: Safe discharge from the cardiac emergency room with a rapid rule-out myocardial infarction protocol using serial CK-MB(mass). Heart 2001, 85:143-148.
• [9]Cassin M, Macor F, Cappelletti P, Rubin D, Deganuto L, Tropeano P, Burelli C, Antonini-Canterin F, Badano LP, Solinas L, Zardo F, Hrovatin E, Brieda M, Quadri ND, Nicolosi GL: Management of patients with low-risk chest pain at the time of admission: a prospective study on a non-selected population from the Emergency Department. Ital Heart J 2002, 3:399-405.
• [10]Edmond JJ, French JK, Henny H, Belz LM, West T, Stewart R, White HD: Prospective evaluation of a chest pain pathway at Green Lane Hospital. N Z Med J 2002, 115:U103.
• [11]Conti A, Paladini B, Toccafondi S, Magazzini S, Olivotto I, Galassi F, Pieroni C, Santoro G, Antoniucci D, Berni G: Effectiveness of a multidisciplinary chest pain unit for the assessment of coronary syndromes and risk stratification in the Florence area. Am Heart J 2002, 144:630-635.
• [12]Menown IB, Mathew TP, Gracey HM, Nesbitt GS, Murray P, Young IS, Adgey AA: Prediction of Recurrent Events by D-Dimer and Inflammatory Markers in Patients with Normal Cardiac Troponin I (PREDICT) Study. Am Heart J 2003, 145:986-992.
• [13]Spalding L, Reay E, Kelly C: Cause and outcome of atypical chest pain in patients admitted to hospital. J R Soc Med 2003, 96:122-125.
• [14]Shaver KJ, Marsan RJ Jr, Sease KL, Shofer FS, Sites FD, Hollander JE: Impact of a negative evaluation for underlying coronary artery disease on one-year resource utilization for patients admitted with potential acute coronary syndromes. Acad Emerg Med 2004, 11:1272-1277.
• [15]Aune E, Hjelmesaeth J, Fox KA, Endresen K, Otterstad JE: High mortality rates in conservatively managed patients with acute coronary syndrome. Scand Cardiovasc J 2006, 40:137-144.
• [16]Aune E, Endresen K, Fox KA, Steen-Hansen JE, Roislien J, Hjelmesaeth J, Otterstad JE: Effect of implementing routine early invasive strategy on one-year mortality in patients with acute myocardial infarction. Am J Cardiol 2010, 105:36-42.
• [17]Aune E: Acute myocardial infarction - consequences of new treatment modalities and smoking status. PhD thesis. University of Oslo, Faculty of Medicine; 2011.
• [18]Leise MD, Locke GR, Dierkhising RA, Zinsmeister AR, Reeder GS, Talley NJ: Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clin Proc 2010, 85:323-330.
• [19]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383.
• [20]Ravn-Fischer A, Karlsson T, Santos M, Bergman B, Johanson P, Herlitz J: Chain of care in chest pain - Differences between three hospitals in an urban area. Int J Cardiol, in press.
• [21]Keller T, Tzikas S, Zeller T, Czyz E, Lillpopp L, Ojeda FM, Roth A, Bickel C, Baldus S, Sinning CR, Wild PS, Lubos E, Peetz D, Kunde J, Hartmann O, Bergmann A, Post F, Lackner KJ, Genth-Zotz S, Nicaud V, Tiret L, Münzel TF, Blankenberg S: Copeptin improves early diagnosis of acute myocardial infarction. J Am Coll Cardiol 2010, 55:2096-2106.
• [22]Meune CT, Reichlin T: Safety of outpatient management of patients with acute chest pain and mildly elevated cardiac troponin levels [abstract]. Eur Heart J 2011, 32:690.
• [23]Zaman MJ, Junghans C, Sekhri N, Chen R, Feder GS, Timmis AD, Hemingway H: Presentation of stable angina pectoris among women and South Asian people. CMAJ 2008, 179:659-667.
• [24]Fruergaard P, Launbjerg J, Hesse B, Jorgensen F, Petri A, Eiken P, Aggestrup S, Elsborg L, Mellemgaard K: The diagnoses of patients admitted with acute chest pain but without myocardial infarction. Eur Heart J 1996, 17:1028-1034.
• [25]Karlson BW, Sjoland H, Wahrborg P, Lindqvist J, Herlitz J: Patients discharged from emergency care after acute myocardial infarction was ruled out: early follow-up in relation to gender. Eur J Emerg Med 1997, 4:72-80.
• [26]Coley KC, Saul MI, Seybert AL: Economic burden of not recognizing panic disorder in the emergency department. J Emerg Med 2009, 36:3-7.
• [27]White KS, McDonnell CJ, Gervino EV: Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain. J Behav Ther Exp Psychiatry 2011, 42:432-439.
• [28]Gillies M, Jhund PS, Macteague K, Macintyre P, Allardyce J, Batty GD, Macintyre K: Prior psychiatric hospitalization is associated with excess mortality in patients hospitalized with non-cardiac chest pain: a data linkage study based on the full Scottish population (1991-2006). Eur Heart J 2012, 33:760-767.