Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments

被引:4
|
作者
Sanfilippo, Frank M. [1 ]
Hillis, Graham S. [2 ,3 ]
Rankin, Jamie M. [4 ]
Latchem, Donald [5 ]
Schultz, Carl J. [2 ,3 ]
Yong, Jongsay [6 ]
Li, Ian W. [1 ]
Briffa, Tom G. [1 ]
机构
[1] Univ Western Australia, Sch Populat & Global Hlth, Perth, WA 6009, Australia
[2] Royal Perth Hosp, Cardiol Dept, Perth, WA 6000, Australia
[3] Univ Western Australia, Med Sch, Perth, WA 6009, Australia
[4] Fiona Stanley Hosp, Cardiol Dept, Murdoch, WA 6150, Australia
[5] Sir Charles Gairdner Hosp, Dept Cardiovasc Med, Nedlands, WA 6009, Australia
[6] Univ Melbourne, Melbourne Inst Appl Econ & Social Res, Melbourne, Vic 3010, Australia
关键词
chest pain; emergency departments; coronary angiography; linked health data; cardiac biomarkers; health services research; gender differences; MANAGEMENT; AUSTRALIA; OUTCOMES; HEART;
D O I
10.3390/ijerph17249502
中图分类号
X [环境科学、安全科学];
学科分类号
08 ; 0830 ;
摘要
We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.
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页码:1 / 12
页数:12
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