Abstract 17268: The CHEER Chest Pain Unit Strategy Guides the Selective Use of Coronary Angiography and Revascularization and is Safe in Intermediate Risk Unstable Angina Patients Followed for 10 Years
Introduction: Select patients with unstable angina (USA) at intermediate risk for short-term cardiovascular events benefit from early use of coronary angiography. However, most patients in the U.S. presenting with USA are at intermediate risk, and further sub-stratification to identify those most likely to benefit from intensive investigation in a resource conscious manner is desirable.
Hypothesis: Utilization of an emergency room (ER) based chest pain unit (CPU) for intermediate risk USA is safe and effective in the long term and can refine the selection of patients for invasive investigation in a safe, resource conscious manner.
Methods: The prospective Chest Pain in ER (CHEER) trial randomized intermediate risk USA patients to hospital admission (n=212) versus an ER based CPU (n=212) using a 6–12 hr period of observation with serial ECGs and biomarkers, followed by stress testing; patients were admitted if any of these parameters were abnormal (n=115) and otherwise discharged to home (n=97). Six month outcomes were comparable between the 2 randomized cohorts, suggesting that a CPU strategy safely sub-stratifies the large cohort of intermediate risk USA patients into those requiring hospitalization and those that could be discharged from the ER. Herein we analyzed the long term outcome of these patients and document the use of coronary angiography and revascularization.
Results: Kaplan Meier estimates of survival at 10 years were comparable between the hospital admission and CPU cohorts (81% vs 84%, p=0.5) as were 1 year rates of angiography and coronary revascularization (38% vs 31%, p=0.35 and 18% vs 14%, p=0.33 respectively). Of the CPU patients dismissed from the ER, angiography and revascularization at 1 year (most of which was within 30 days) was required far less frequently than CPU patients triaged to hospital admission based on the results of their CPU stay (8% vs 51%, p< 0.001 and 2% vs 25%, p < 0.001 respectively).
Conclusions: Over the course of 10 year follow-up, a CPU can safely and effectively sub-stratify intermediate risk USA patients into those requiring admission and those that can be safely dismissed from the ER. Such a strategy can also identify those patients more likely or less likely to require coronary angiography and revascularization.
- © 2010 by American Heart Association, Inc.