Seguimiento alejado de pacientes evaluados en una Unidad de Dolor Torácico / Long term follow up of patients consulting in a Chest Pain Unit

Background: Chest pain (CT) constitutes an important cause of consultation and diagnostic dilemma in the emergency room, especially due to the possible presence of coronary disease. Its presentation, diagnosis and prognosis are different between men and women. Aim: To report a follow-up of patients attended at a Chest Pain Unit (CPU), evaluating gender differences. Material and Methods: Prospective evaluation of patients that consulted for chest pain in a period of 4 years. Baseline characteristics and the final diagnosis from CPU or hospitalization were registered. Telephonic follow-up was performed for at least one year. Mortality was determined using the national mortality registry. Results: A total of 1,168 patients aged 62 ± 23 years, 69 percent men, were followed for a mean of 28 ± 20 months. A definitive diagnosis of coronary disease (CD) was done in 32 percent. Mortality among women and men with CD was 28 and 14 percent respectively (p = 0,02). Predictor variables for mortality were the presence of a complete left branch block in the initial electrocardiogram, with an odds ratio (OR) of 12,5 (95 percent confi dence intervals (CI): 1,98-25,8), the presence of coronary disease with an OR of 3,98 (95 percent CI: 1,45-13,8) and elevated troponin I with an OR 2,12 (95 percent CI: 1,05-7,89). Female gender lost significance in the adjusted model. Conclusions: Complete left branch block, elevated troponin I and coronary etiology of CP are indicators of bad prognosis among patients that consult for CP. Women have twice the mortality of men after 28 months of follow-up.

[Long term follow up of patients consulting in a Chest Pain Unit]. / Seguimiento alejado de pacientes evaluados en una Unidad de Dolor Torácico.

BACKGROUND: chest pain (CT) constitutes an important cause of consultation and diagnostic dilemma in the emergency room, especially due to the possible presence of coronary disease. Its presentation, diagnosis and prognosis are different between men and women. AIM: to report a follow-up of patients attended at a Chest Pain Unit (CPU), evaluating gender differences. MATERIAL AND METHODS: prospective evaluation of patients that consulted for chest pain in a period of 4 years. Baseline characteristics and the final diagnosis from CPU or hospitalization were registered. Telephonic follow-up was performed for at least one year. Mortality was determined using the national mortality registry. RESULTS: a total of 1,168 patients aged 62 ± 23 years, 69 % men, were followed for a mean of 28 ± 20 months. A definitive diagnosis of coronary disease (CD) was done in 32 %. Mortality among women and men with CD was 28 and 14% respectively (p = 0,02). Predictor variables for mortality were the presence of a complete left branch block in the initial electrocardiogram, with an odds ratio (OR) of 12,5 (95% confi dence intervals (CI): 1,98-25,8), the presence of coronary disease with an OR of 3,98 (95% CI: 1,45-13,8) and elevated troponin I with an OR 2,12 (95% CI: 1,05-7,89). Female gender lost significance in the adjusted model. CONCLUSIONS: complete left branch block, elevated troponin I and coronary etiology of CP are indicators of bad prognosis among patients that consult for CP. Women have twice the mortality of men after 28 months of follow-up.