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Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments

Author

Listed:
  • Frank M. Sanfilippo

    (School of Population and Global Health, The University of Western Australia, Perth 6009, Australia)

  • Graham S. Hillis

    (Cardiology Department, Royal Perth Hospital, Perth 6000, Australia
    Medical School, The University of Western Australia, Perth 6009, Australia)

  • Jamie M. Rankin

    (Cardiology Department, Fiona Stanley Hospital, Murdoch 6150, Australia)

  • Donald Latchem

    (Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands 6009, Australia)

  • Carl J. Schultz

    (Cardiology Department, Royal Perth Hospital, Perth 6000, Australia
    Medical School, The University of Western Australia, Perth 6009, Australia)

  • Jongsay Yong

    (Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne 3010, Australia)

  • Ian W. Li

    (School of Population and Global Health, The University of Western Australia, Perth 6009, Australia)

  • Tom G. Briffa

    (School of Population and Global Health, The University of Western Australia, Perth 6009, Australia)

Abstract

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.

Suggested Citation

  • Frank M. Sanfilippo & Graham S. Hillis & Jamie M. Rankin & Donald Latchem & Carl J. Schultz & Jongsay Yong & Ian W. Li & Tom G. Briffa, 2020. "Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments," IJERPH, MDPI, vol. 17(24), pages 1-12, December.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:24:p:9502-:d:464415
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    Cited by:

    1. Antonio Sarría-Santamera & Alua Yeskendir & Tilektes Maulenkul & Binur Orazumbekova & Abduzhappar Gaipov & Iñaki Imaz-Iglesia & Lorena Pinilla-Navas & Teresa Moreno-Casbas & Teresa Corral, 2021. "Population Health and Health Services: Old Challenges and New Realities in the COVID-19 Era," IJERPH, MDPI, vol. 18(4), pages 1-5, February.

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