Abstract
The aim of this study was to record prognosis for patients with stable chest pain referred for outpatient cardiac assessment. All 660 patients in the study had a normal resting ECG and no history of myocardial infarction, unstable angina or coronary revascularisation. Main outcome measures were all-cause mortality, non-fatal ischaemic events and coronary revascularisation. Cardiac chest pain was diagnosed in 182 patients (28%). It was more frequent in patients with recent onset of symptoms (<6 months), patients over 50, white patients, and patients with hypertension or diabetes. The mean follow-up was 622 ± 338 days. Among survivors, 37% continued to suffer from symptoms (cardiac group: 59 (35.1%); non-cardiac group: 177 (38.4%)). When all hard events were considered, event-free survival (95% confidence interval) for the cardiac group was 90.9% (86.7–95.2%) at six months, 88.9% (84.2–93.6%) at one year, and 83.6% (77.5–89.7%) at two years. Corresponding figures for the non-cardiac group at the same time points were better (p <0.0001): 98.5% (97.4–99.6%), 97.5% (96.1–99.0%) and 96.6% (94.7–98.5%), respectively. In conclusion, the use of clinical criteria in a cardiac outpatient clinic, backed up by simple non-invasive investigations, can reliably identify a population at high risk of subsequent cardiac events.
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Contributor Information
D Jain, Research SHO in Cardiology, Newham General Hospital.
D Fluck, Registrar in Cardiology, London Chest Hospital.
J W Sayer, Registrar in Cardiology, London Chest Hospital.
S Ray, Research SHO in Cardiology, Newham General Hospital.
E A Paul, Lecturer in Medical Statistics, London Hospital Medical College.
A D Timmis, Consultant Cardiologist, London Chest Hospital.