Natural history and predictors of outcome for non-cardiac chest pain: a prospective 4-year cohort study

The natural history of non-cardiac chest pain (NCCP) is poorly understood. We aimed to assess the 2- and 4-year outcomes of patients with chest pain, and determine whether baseline characteristics could predict outcomes (mortality, continued chest pain and quality of life). This was a prospective cohort study in a tertiary teaching hospital (Nepean Hospital), Sydney, Australia. All subjects who presented with acute chest pain to the emergency department were recruited at baseline (n = 197). Mortality data were obtained from death certificates on the entire cohort at 4 years; 129 (65%) patients responded to a 2 year follow-up and 92 (47%) to a 4-year follow-up questionnaire. At baseline, there were 126 (60%) NCCP patients and 71 cardiac patients. Chest pain continued to be reported in the majority of individuals (> 65%) at follow-up. Over the 2-year period, NCCP disappeared among 10% (n = 9/88), but remained present in the remaining 90% (n = 79). In comparison, 69% (n = 28/41) of the cardiac chest pain (CCP) patients continued to have chest pain at the 2-year follow-up (NCCP vs CCP: P < 0.001). At the 4-year follow-up, 71% (n = 45/64) and 81% (23/27) continued to have NCCP and CCP respectively. The mortality rate among the entire cohort over the 4-year study was 9% (17/197). The cardiac mortality rate for patients initially diagnosed with CCP was 11% (8/71); compared with 5.5% (7/126) (P = 0.16) among patients initially diagnosed with NCCP who subsequently died from a cardiac cause. Outcomes in terms of mortality did not significantly differ between cardiac and NCCP patients. Both groups experienced continued chest pain during the follow-up period. Non-cardiac chest pain does not always confer an excellent long-term prognosis.