48 Predictors of revascularisation in patients with typical angina presenting to the rapid access chest pain clinic. (17th July 2020)

• Record Type: Journal Article
• Authors: Gall, Alexander; Mora, Jessica; Connolly, Georgia; Kashyap, Mavin; Dastidar, Amardeep; Joshi, Nikhil; Dorman, Stephen; De Silva, Kalpa; Strange, Julian; Johnson, Tom; Sammut, Eva
• Is Part Of: Heart. Volume 106(2020)Supplement 2
• Page Start: A39
• Page End: A40
• Publication Date: 2020-07-17
• Subjects: Chest pain clinic -- ACS -- Revascularisation; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-BCS.48
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: In the UK, the rapid access chest pain clinic (RACPC) is increasingly used as an open access resource for patients with chest pain presenting to GP surgeries or Emergency Departments. Patients are not uncommonly admitted for inpatient investigation and treatment from RACPC. This study aimed to assess the outcome of patients presenting to our RACPC and look for predictors of acute coronary syndrome and revascularisation. Methods: Electronic notes of all patients assessed in our high-volume Rapid Access Chest Pain Clinic (RACPC) within a 12-month period (2018–19) were reviewed. Patients admitted directly from RACPC with ACS were compared to those felt to have typical anginal symptoms who were managed on an outpatient basis. Information on demographics, symptoms, initial investigations and management were obtained. Results: 2416 patients were assessed in the RACPC during the study period. Of these, 378 (15.6%) presented with symptoms thought to represent typical anginal chest pain (CP), 1357 (56.2%) had atypical CP and 681 (28.2%) had non-anginal CP. Patients with typical angina had a median age of 68 years, 121 (22%) female, 216 (57%) had high cholesterol, 86 (23%) had diabetes, 220 (58%) had hypertension, 175 (46%) had a family history, and 218 (58%) were current or ex-smokers. The mean number of risk factors in those presenting with typical CP was 2.7. See Table 1 . On univariate analysis regression, gender, ACS presentation, ischaemic ECG changes and regional wall motion abnormality on echocardiogram were predictors of revascularisation, however on multivariate analysis only gender (OR 2.447, CI 1.336-4.480, p=<0.004) and ACS presentation (OR 4.286, CI 2.174-8.448, p=<0.001) were found to be significant. Of those admitted from RACPC with suspected ACS, 76 (96%) patients underwent inpatient invasive coronary angiogram (ICA). 45 (56.7%) patients subsequently underwent revascularisation (35 underwent PCI, 10 underwent surgical revascularisation). 1 patient was found to have unobstructed coronary arteries and was diagnosed with severe aortic stenosis, subsequently undergoing inpatient aortic valve replacement. All patients underwent an echocardiogram, 31 (40%) patients were found to have a regional wall motion abnormality. On logistic regression of all variables within the ACS cohort including age, gender, risk factors and baseline ECG, only troponin was found to be a predictor of revascularisation (OR 2.76, CI 1.09-7.03, p value 0.03). Conclusion: The rapid access chest pain clinic is a valuable resource for prompt assessment of patients with suspected cardiac pain. Our experience suggests patients seen with typical angina represent a high-risk group with high rates of revascularisation, particularly in those with suspected ACS. Within our cohort, predictors of revascularisation were ACS presentation and male gender. Conflict of Interest: None