Thirty-day outcome of patients who present with chest pain to the emergency department of a tertiary care hospital of Sri Lanka

Background: Patients present with chest pain causes significant burden to the workload in an emergency department (ED). Quick but thorough attention is needed for life threatening emergencies and to minimize unnecessary admissions. We assess the burden of chest pain and 30-day outcome of patients who present with chest pain to the ED.

Methodology: Prospective observational study of all adult patients presented to ED over one month with the primary complain of chest pain were evaluated and followed for 30 days.

Results: A total of 661 (20.3% of total admissions) patients (mean age 56.7±1 4.9 years, 51% males) were studied. Common causes for the chest pain included gastroesophageal reflux disease (GORD) (29%) and acute coronary syndrome (ACS) (25%). ACS patients included ST-elevation myocardial infarction (STEMI) (10%), Non-ST-elevation myocardial infarction (6.7%) and unstable angina (8.3%). Fifty patients (75% of the STEMI patients) were thrombolysed. Primary angioplasty facility was not available in the hospital during the study period. Five patients (3% of the ACS patients) had coronary revascularization during the follow-up period – 2 patients had angioplasty and 3 patients had coronary bypass surgery. In-hospital mortality was 2.7%. Thirty-day mortality was 3.2%. Thirty three percent of them continued to have recurrent chest pain despite thorough investigation and treatment.

Conclusions: Chest pain carries a significant burden to the workload of a busy ED. The commonest causes for chest pain were ACS and GORD. A considerable number of patients continued to experienced chest pain despite investigations and treatment.