Incidence of thirty-day major adverse cardiac event among patients presenting to emergency department with low-risk chest pain in a tertiary care hospital

Abstract

Current guidelines for low-risk chest pain patients recommend obtaining serial ECGs and serial

measurements of cardiac troponin between 6 and 12 hours, thereby requiring prolonged assessment before
safe discharge. There is need to identify these patients promptly to reduce time to treatment as well as reduce
burden over emergency department (ED). The current study aimed to estimate the incidence of a thirty-day
Major Adverse Cardiac Event (MACE) in patients presenting to the ED with low-risk chest pain, and to
compare the “Thrombolysis in Myocardial Infarction” (TIMI), “HEART”, and “Emergency Department
Assessment of Chest Pain Score” (EDACS) among patients having low-risk chest pain. The current
investigation was a descriptive follow-up study conducted at a tertiary care hospital (Fortis Memorial
Research Institute in Gurugram, Haryana, India). The data collection took place from Jan 2018 to Jan 2019.
All patients reporting with low-risk chest pain during study period were recruited. The outcome variable was a
MACE (major adverse cardiac event) in 30 days. The study involved a total of 156 individuals. Mean age of
participants was 44.1 years. Ten participants (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. EDACS and HEART score can be used in ED to identify
low-risk chest pain patients. This could help in early identification, saving time and other resources.