Skip to main content
  • Home
  • Articles
    • Archive from 2022 July
    • Archive 1960 to 2022 June
    • Accepted Articles
    • Published Ahead-of-Print
    • Supplement
  • About
  • For Authors
  • Podcasts

Comparison of a 6-hour and 9-hour Protocol for Evaluation of Moderate-to-Low Risk Chest Pain Patients in an Emergency Department Diagnostic Unit

< Back to Listing

Share this Article

Singapore Med J 2001; 42(2): 52-56
Comparison of a 6-hour and 9-hour Protocol for Evaluation of Moderate-to-Low Risk Chest Pain Patients in an Emergency Department Diagnostic Unit

  • Abstract
  • PDF

F Lateef, AB Storrow, K Malone, T Liu, BW Gibler
Correspondence: Dr Fatimah Lateef, f_lateef@hotmail.com; gaefal@sgh.gov.sg

ABSTRACT
Objective
To compare the 30-day outcomes of patients enrolled in a 6-hour and 9-hour emergency department (ED)-based chest pain centre (CPC) protocol.
Methods All patients with the chief complaint of chest pain, who were older than 25 years, or with cocaine usage within 96 hours of initial presentation, were eligible for enrolment. Exclusion criteria included acute ST-segment elevation or depression >1 mm in 2 contiguous leads, history of coronary artery disease (CAD), haemodynamic instability or clinical syndromes consistent with unstable angina. Outcomes included ED disposition and cardiac events at 30 days (defined as acute myocardial infarction (AMI), percutaneous trans-luminal coronary angiography (PTCA), coronary artery bypass graft surgery (CABG),ventricular tachycardia or fibrillation (VT/VF) arrest, congestive heart failure (CHF) admission or cardiac-related death). The 9-hour protocol consisted of ST-segment monitoring,serial CK-MB draws at 0, 3,6 and 9 hours as well as a graded exercise test (GXT) prior to ED disposition. The 6-hour protocol eliminated the 9-hour serum marker determination, included cardiac Troponin-I (cTn-I) and allowed a GXT, 3 hours earlier. Follow-up was obtained by medical record review, phone contact, letter and also review of national and state death registries.
Results The 9-hour protocol (October 1991-December 1997) included 2,133 patients and the 6-hour protocol (January 1998- August 1998) had 184 patients enrolled. The 6-hour protocol was not different from the 9-hour one in terms of percentage admissions (9-hour: 310, 14.5%; 6-hour: 33, 17.9%; p=0.213), Coronary Care Unit admission (9-hour: 59, 2.8%; 6-hour: 5, 2.7%; p=0.303) or 30-day cardiac events (9-hour: 38, 1.9%; 6-hour: 2, 1.3%; p=0.605).
Conclusion The 6-hour CPC strategy is an effective and safe evaluation method for patients at low to moderate risk for acute coronary syndromes.

Keywords: Chest pain centre, acute coronary syndrome
Singapore Med J 2001; 42(2): 52-56

http://smj.org.sg/sites/default/files/4202/4202a1.pdf
×

Around the Site

Home

About SMJ

For Reviewers

Sign Up for Alerts

Issues

Current Issue

All Issues

Online First

Supplement

CME

For Authors

Instructions for Authors

Submit Manuscript


Follow us on:
        

More Links

Contact Us

Copyright

Advertise

SMJ Forms

Privacy Policy

SMA Home

Copyright 2021. Singapore Medical Association. All Rights Reserved.