LONG-TERM RISK OF DEATH, CARDIAC EVENTS AND RECURRENT CHEST PAIN IN PATIENTS WITH ACUTE CHEST PAIN OF DIFFERENT ORIGIN

The purpose of the study was to describe the prognosis of patients wit h acute chest pain of different origin, but without myocardial infarct ion (non-AMI). A total of 204 patients were included. In 56, a definit e diagnosis was obtained within 24-48 h of admission. The remaining 14 8 patients underwent the following examinations: exercise test, myocar dial scintigraphy, echocardiography, Holter monitoring, hyperventilati on test, oesophago-gastro-duodenoscopy, oesophageal manometry, oesopha geal pH monitoring, Bernstein test, physical chest wall examination, b ronchial histamine test, chest X-ray and ultrasonic upper abdominal ex amination. Ischaemic heart disease (IHD) was diagnosed in 64 patients, 81 had gastro-oesophageal disorders, 58 chest wall disorders, 9 peric arditis, 5 pulmonary embolism, 4 pneumonia/pleuritis, 3 pulmonary canc er, 2 dissecting aortic aneurysm, 1 aortic stenosis and 1 herpes teste r. During follow-up of 33 months, 3 1 of the 64 patients with IHD had a cardiac event (cardiac deaths, non-fatal AMI, bypass surgery or PTCA ), whereas only 3 events occurred among the 140 patients without IHD ( p < 0.00001). However, the frequency of readmissions and of recurrent episodes of chest pain were similar in the 3 major diagnostic groups ( NS). To conclude, the high-risk subset of a non-AMI population can be identified by means of non-invasive cardiac examination. The remainder who have other diagnoses are at low risk. However, the morbidity is h igh with frequent readmissions and recurrent episodes of chest pain an d the need for development of strategies with regard to diagnosis and treatment of these patients are emphasized.