Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 1, January, p. 147–155

doi: 10.17219/acem/110325

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Predictors of mortality in emergency department patients with chest pain without cardiovascular emergencies

Przemysław Skoczyński1,A,B,C,D,E,F, Joanna Wizowska1,A,B,C,D,E,F, Paweł Pochciał1,A,B,D,E,F, Marcin Leśkiewicz2,A,B,E,F, Dorota Zyśko1,A,C,D,E,F

1 Department and Clinic of Emergency Medicine, Wroclaw Medical University, Poland

2 Department of Medical Emergency, Wroclaw Medical University, Poland

Abstract

Background. Chest pain is one of the most frequent symptoms in patients seeking treatment at emergency departments (ED). These patients differ according to the cause of their reported symptoms and resultant mortality.
Objectives. Evaluation of the influence of hospitalization and biochemical parameters on mortality rates in patients admitted to the ED with chest pain, in whom no cardiovascular emergencies were established.
Material and Methods. The study group consisted of 243 patients with chest pain admitted to the ED in the Wroclaw Medical University Clinical Hospital, Poland, between January 1 and March 31, 2015, in whom no specific diagnosis was made at discharge. A retrospective analysis was carried out based on medical documentation, and 60-day and 1-year survival was assessed.
Results. In the study group, the 60-day mortality rate was 0.8% (2 persons) while the 1-year mortality rate was 6.6% (16 persons). The stepwise multivariable logistic regression analysis revealed that 1-year mortality was related to increased level of D-dimer (odds ratio (OR) = 8.5, 95% confidence interval (95% CI) = 21.9–37.5, p < 0.005), age (OR (per year) = 1.10, 95% CI = 1.03–1.18, p < 0.03) and lower than 12 g/dL hemoglobin concentration (OR = 18.5, 95% CI = 4.2–80.4, p < 0.001). Troponin I (TNI) levels and hospitalization were not related independently to mortality when other clinical factors were considered.
Conclusion. Hospitalization of patients with chest pain who were not diagnosed with cardiac emergencies is not related with better survival than of those discharged home from the ED. The 60-day mortality is very low and occurs in older patients with numerous comorbidities. In multivariate analysis, survival of the 1-year period depends on the patient’s age, hemoglobin levels and D-dimer levels. Risk of death in patients admitted to the ED due to chest pain in whom the cause of the chest pain was not due to cardiovascular emergencies depends on the presence of old age and comorbidities.

Key words

hospitalization, emergency department, D-dimer, chest pain, troponin I

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