Incidence of Thirty-day MACE among patients presenting to emergency department with low-risk chest pain in a tertiary care hospital: A prospective study
Authors: Khokhar Sanwar , Jaiswal Abhishek , Abhi Raman , Reza Mohammed Hasnain 
Published: May 2022

Background

Current guidelines for low-risk chest pain patients recommend obtaining serial ECGs and serial measurements of cardiac troponin between 6 and 12 hours. As a result, the majority of patients require prolonged assessment before safe discharge. There is a need to identify these patients promptly to help in reducing the time to provide the treatment as well as reduce the burden over the ED. Present study was done with the objective of estimating the incidence of thirty-day Major Averse Cardiac Event (MACE) in patients presenting to emergency department with low-risk chest pain, and to compare the Thrombolysis In Myocardial Infarction (TIMI), HEART and Emergency Department Assessment of Chest Pain Score (EDACS) Score in patients with low-risk chest pain.

Methods

Present study was descriptive follow up study done at a tertiary care hospital (Fortis Memorial Research Institute, in Gurugram, Haryana, India. Study was conducted from Jan 2018 to Jan 2019. All the patient reporting with low-risk chest pain during study period were recruited in the study. Semi-structured interview schedule was used for the data collection. Outcome variable was MACE (Major adverse cardiac event) event in 30 days.

Results

Total 156 participants were included in the study. Mean age of participants was 44.1 years. Out of 156 participants, 10 (6.4%) reported MACE in 30 days of presentation. We found that HEART and EDACS score had incidence of MACE less than 2% in their low-risk groups and TIMI score had incidence of MACE >2% in its low-risk group.

Conclusion

EDACS and HEART score can be used in the Emergency department to identify the low-risk chest pain patients. This could help in early identification and save time and other resources.

What is already known on this topic

Current guidelines for low-risk chest pain patients recommend obtaining serial ECGs and serial measurements of (non-high sensitivity) cardiac troponin between 6 and 12 hours after patient presentation to the ED. As a result, the majority of patients require prolonged assessment before safe discharge. Prolonged assessment leads to increased health care costs and ED crowding, which has been shown to lead to increased adverse events in patients with both acute and non-acute coronary syndrome–related chest pain. The efficient identification of low-risk patients who can be safely discharged after rapid assessment in the ED remains an important issue. Risk assessment scores have been developed for chest pain, among these few are TIMI score, Heart score, and EDACS score.

What this study adds

Overall incidence of 30-day MACE was less 10% among the patients presenting to emergency department of FMRI Gurugram, Haryana with low-risk chest pain. HEART, and EDACS scores performed better in identifying the low-risk category than the TIMI score. Among these EDACS was the best, with none of the participants in low-risk category having 30-day MACE.

How this study might affect research, practice or policy

EDACS and HEART score can be used in the Emergency department to identify the low-risk chest pain patients. This could help in early identification and save time and other resources.