Long-Term Outcome Of Low-Risk Patients Attending A Rapid-Assessment Chest Pain Clinic

Objective: To examine the long-term outcome of patients evaluated in a rapid assessment chest pain clinic (RACPC): are "low-risk'' patients safely reassured?Design: Retrospective cohort study.Setting: Staff grade-led RACPC in an urban teaching hospital.Participants: 3378 patients (51% male), attending the RACPC between April 1996 and February 2000.Main outcome measures: Death, coronary mortality, morbidity and revascularisation over a median follow-up of 6 years. Coronary standardised mortality ratio (SMR).Results: 2036 (60.3%) patients were categorised as "low risk'', 957 (28.3%) as having "stable coronary artery disease'' and 214 (6.3%) as being an "acute coronary syndrome''. During the study, 3.6% of patients in the low risk category, 11.9% in the stable coronary artery disease category and 24.6% in the acute coronary syndrome category died from coronary artery disease or had a myocardial infarction. 5.5%, 18.2% and 18.4%, respectively, died from any cause. Compared to the local population ( coronary SMR = 100), our "low risk/non-coronary chest pain'' cohort had a coronary SMR of 51 (95% CI 31 to 83), the "stable coronary artery disease'' cohort 240 ( 187 to 308) and the "acute coronary syndrome'' cohort 780 ( 509 to 1196).Conclusion: The RACPC was effective at triaging patients with chest pain. Patients identified as at "low risk'' were unlikely to have an adverse coronary outcome and were appropriately reassured.