Outcome of chest pain patients discharged from a French emergency department: a 60-day prospective study

Background: Chest pain (CP) is a common complaint among patients presenting to the emergency department (ED). Previous studies suggest that between 2% and 5% of ED patients who present with CP and are sent home develop an acute coronary syndrome within 30 days. In France, no prospective data are available concerning the outcome of CP patients discharged from the ED.

Objective: The objective of our study was to determine the rate of adverse cardiac events (ACE) within a period of 60 days after discharge from the ED.

Methods: From October 2007 to February 2008, consecutive patients aged 25 years or more who presented to the ED with CP were prospectively included. Patients discharged from the ED were contacted by phone at 60 days to determine their clinical course and the occurrence of an ACE.

Results: There were 322 CP patients enrolled, representing 3.9% of all medical admissions to the ED; 40.4% of these patients were hospitalized and 59.6% were discharged. Three patients (1.6%) could not be contacted for follow-up, leaving 189 patients eligible for the study. The rate of ACE was 3.7%: one ST-segment elevation myocardial infarction and six non-ST-segment elevation myocardial infarctions. Follow-up revealed that 39.1% of patients saw a cardiologist and that 14.2% were readmitted for CP.

Conclusion: We found that CP is a frequent complaint in patients who present to our ED, and that a small proportion (3.7%) is mistakenly discharged and presents with an ACE during the 60-day follow-up period.