Outcomes after Non-Cardiac Chest Pain Visits to the ER

Acute-onset chest pain is an excellent reason to go to the ER post-haste.  It might be a heart attack.  But if it isn’t, what happens to patients who are discharged directly from the ER after an acute coronary syndrome has been “ruled out” as the cause of chest pain?  An article in the Mayo Clinic Proceedings has addressed this situation.

A series of patients presenting to the ER with chest pain between January 1985 and December 1992 were followed.  There were 320 who were diagnosed as non-cardiac chest pain; 22% of them had had a prior heart attack.  Of the 320, 49% were fully evaluated in the ER, 42% had repeated cardiology evaluations, and 15% were assessed by a gastroenterologist.  Only 40% of those referred for gastrointestinal (GI) evaluation had diagnostic testing. 

The numbers of gastroenterology consultations is surprisingly low, given that gastro-esophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain – accounting for as many as 60% of ER chest-pain visits.  And the number of GI diagnostic tests was even lower.

It’s interesting to compare the reported 10-year and 20-year death rates in the non-cardiac chest pain with a gastrointestinal disorder and those without a diagnosed cause: 90% (10-year) and 85% (20-year) for those with a GI disorder, and 94% (10-year) and 88% (20-year) for those with no diagnosed cause.  Maybe a little more attention should be paid to those with GI-related chest pain?