Chest Pain Unit (CPU) in the Management of Low to Intermediate Risk Acute Coronary Syndrome: A Tertiary Hospital Experience from New Zealand

Background: A chest pain unit (CPU) for management of patients with chest pain at low to intermediate risk for acute coronary syndrome (ACS) appears safe and cost-effective. We report our experience with a CPU from March 2005 to July 2009. Methods: Prospective audit of patients presenting with chest pain suggestive of ACS but no high risk features and managed using a CPU, which included; serial cardiac troponins and electrocardiography and exercise tolerance test (ETT) if indicated. Outcomes assessed included three-month readmission rate and one year mortality. Results: 2358 patients were managed according to the CPU. Mean age 56 years (17-96 years), 59% men and median stay of 22 h (IQR 17-26 h). 1933 (82%) were diagnosed as non-cardiac chest pain. 1741 (74%) patients had an ETT. Median time from triage to ETT was 21 h (IQR 16-24 h). 64 (2.7%) were readmitted within three months. The majority of readmissions, 39 (61 /0) were for a non-cardiac cause. Twenty patients (1%) were readmitted with ACS. There was no cardiac death after one year of being discharged as non-cardiac chest pain. Conclusions: This study confirms that a CPU with high usage of predischarge ETT is a safe and effective way of excluding ACS in patients without high risk features in a New Zealand setting. (Heart, Lung and Circulation 2013;22:110-115) (C) 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.