Abstract

Objective To examine the long-term outcome of patients evaluated in a rapid assessment chest pain clinic (RACPC): are "low-risk" patients safely reassured?

Design Retrospective cohort study.

Setting Staff-Grade led RACPC in an urban Teaching hospital.

Participants 3,378 patients (51% male), attending the RACPC between April 1996 and February 2000.

Main outcome measures Death, coronary mortality, morbidity and revascularisation over a median follow up of 6 years. Coronary standardised mortality ratio (SMR).

Results 2,036 (60.3 per cent) patients were categorised as "low risk", 957 (28.3 per cent) as having "stable coronary artery disease" and 214 (6.3 per cent) as an "acute coronary syndrome". During the study, 3.6 per cent of patients in the low risk category, 11.9 per cent in the stable coronary artery disease category and 24.6 per cent in the acute coronary syndrome category died from coronary artery disease or had a myocardial infarction. 5.5, 18.2 and 18.4 per cent, respectively, died from any cause. Compared to the local population (coronary SMR = 100), our "low risk/non coronary chest pain" cohort had a coronary SMR of 51 (95% CI 31-83), the "stable coronary artery disease" cohort 240 (187-308) and the "acute coronary syndrome" cohort 780 (509-1196).

Conclusion The RACPC was effective at triaging patients with chest pain. Patients identified as at "low risk" were unlikely to have an adverse coronary outcome and were appropriately reassured.