An evaluation of the use of investigations in a nurse-led rapid access chest pain clinic

2021 ◽  
pp. 1-14
Author(s):  
Chun Shing Kwok ◽  
Debbie Jackson ◽  
Sadie Bennett ◽  
Jacopo Tafuro ◽  
Adrian Large ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Coronary Intervention ◽  
Service Evaluation ◽  
Pain Clinic ◽  
Common Symptom ◽  
Rapid Access ◽  
Accident And Emergency ◽  
Percutaneous Coronary ◽  
Cardiology Clinic

Background/Aims Chest pain is a common symptom, but its presentation and cause varies widely, making diagnosis a challenge. This study describes the authors' experience of a nurse-led rapid access chest pain clinic, and associated use of investigation and patient outcomes. Methods A retrospective service evaluation of patients referred to a nurse-led rapid access chest pain clinic was performed. Routinely-recorded data on patient demographics, symptoms, comorbidities, medications, cardiology clinic attendances and investigations were collected. In addition, admissions to accident and emergency or inpatient, death, acute myocardial infarction and percutaneous coronary intervention within 1 year were obtained. Results A total of 279 patients were included in the evaluation between January and February 2019. Chest pain was present as a symptom in 92.8% of patients, while 37.6% of patients had shortness of breath. Only 16.8% had typical angina, while 34.4% had atypical angina. The majority (93.9%) had two or fewer cardiology clinic appointments, the most common imaging investigation used was computed tomography coronary angiogram (47.3%) and 8.2% had a stress echocardiogram or invasive angiogram. Approximately one in five patients had a hospital admission within 1 year. The mortality rate within 1 year was 1.4%, but were all non-cardiac causes. Only 3.6% underwent percutaneous coronary intervention and there was only one mortality. Conclusions This service evaluation shows that a nurse-led rapid access chest pain clinic can be safe, efficient and closely adhere to National Institute for Health and Care Excellence guidelines. Many patients do not require unnecessary and potentially harmful investigations and revascularisation rates are low.

scholarly journals Acute Pericarditis after Percutaneous Coronary Intervention: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 490
Author(s):  
Greta Rodevič ◽  
Povilas Budrys ◽  
Giedrius Davidavičius
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Troponin I ◽  
Stable Condition ◽  
Coronary Intervention ◽  
Prior History ◽  
Acute Pericarditis ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Background: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. Case Summary: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. Conclusions: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.

scholarly journals Unusual Cause of Chest Pain after Percutaneous Coronary Intervention

2020 ◽  
Vol 08 (01) ◽  
pp. 83-85
Author(s):  
Mohd Iqbal Dar ◽  
Arshed H Parry ◽  
Amir Rashid ◽  
Hilal A Rather ◽  
Nisar A Tramboo
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Abstract 71: Causes of 30-day Readmission Rates after Percutaneous Coronary Intervention - Lessons from Direct Chart Review

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Jason H Wasfy ◽  
Jordan B Strom ◽  
Kenneth Rosenfield ◽  
Adrian Zai ◽  
Jennifer M Luttrell ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Medical Record ◽  
Stent Thrombosis ◽  
Massachusetts General Hospital ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Readmission Rates ◽  
Quality Metric ◽  
Percutaneous Coronary

Background: Policymakers have designated 30-day readmission after percutaneous coronary intervention (PCI) as an important quality metric. Nevertheless, detailed descriptions of the causes and preventability of readmissions after PCI are lacking, leading some to question the usefulness of readmission as a quality metric. Determination of the causes of 30-day readmissions can help clarify the clinical validity of this measure and enable hospitals to develop strategies to reduce readmission rates. Methods: We identified all readmissions after PCI at the Massachusetts General Hospital occurring within 30 days of discharge from 2007 - 2011. For patients with multiple readmissions, only the first readmission was included. Detailed patient medical record reviews were conducted to ascertain documented reasons for readmission. Results: Among 5573 patients receiving PCI, we identified 651 readmissions within 30 days for medical record review representing 625 unique readmitted patients (11.2%). Of these, 241 readmissions (37.0%) were for the evaluation of chest pain, pressure, or other symptoms concerning for angina without an immediately obvious stent thrombosis. Of those, 21 required repeat PCI (8.7%) and 3 (1.2%) required CABG. Forty patients (6.1%) were readmitted for planned, staged procedures in the absence of new symptoms (“staged PCI”); 18 patients (2.8%) were readmitted non-urgently for peripheral vascular procedures or surgery unrelated to the PCI procedure; 24 patients (3.7%) were admitted for vascular or bleeding complications of the PCI procedure. Conclusions: In this single center study, the largest proportion of readmissions after PCI is due to symptoms that prompt concern for angina, the overwhelming majority of which (90.0%) do not require repeat revascularization. Hospitals may be able to minimize 30-day readmission rates after PCI substantially by postponing non-urgent, non-coronary procedures after PCI. Transferring the evaluation of low-risk chest pain to the outpatient setting or to emergency department observation units could dramatically reduce 30 day readmission rates after PCI. Table 1: Main reason for readmission (N = 651) Chest pain or other symptoms concerning for angina - 238 (36.6%) ** Subset of those patients who received repeat PCI - 21 (3.2%) Staged PCI - 40 (6.1%) Stent thrombosis - 19 (2.9%) Sudden cardiac death - 4 (0.6%) Elective peripheral procedure or surgery not related to PCI - 18 (2.8%) Elective CABG - 14 (2.2%) ** Subset of those patients with failed PCI - 10 (1.5%) ** Subset of those patients with staged CABG after PCI - 4 (0.6%) Vascular/bleeding complication of PCI - 24 (3.7%) Atrial fibrillation - 11 (1.7%) Congestive heart failure - 39 (6.0%) Cholecystitis or cholangitis - 7 (1.1%) Gastrointestinal hemorrhage - 25 (3.8%) Venous thromboembolism - 6 (0.9%) Pneumonia - 10 (1.5%) Urinary tract infection - 9 (1.4%)

scholarly journals Chest pain after percutaneous coronary intervention in patients with stable angina

2016 ◽  
Vol Volume 11 ◽  
pp. 1123-1128 ◽  
Author(s):  
Cheng-Wen Chiang ◽  
Chao-Chien Chang ◽  
Yueh-Chung Chen ◽  
Eng-Thiam Ong ◽  
Wei-Cheng Chen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Nonischemic Chest Pain Following Successful Percutaneous Coronary Intervention at a Regional Referral Centre in Southern Ontario

2012 ◽  
Vol 28 (2) ◽  
pp. S60-S69 ◽  
Author(s):  
Michael McGillion ◽  
Heather M. Arthur ◽  
Madhu Natarajan ◽  
Allison Cook ◽  
Elizabeth Gunn ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Coronary Intervention ◽  
Referral Centre ◽  
Southern Ontario ◽  
Percutaneous Coronary

scholarly journals Progression of left anterior descending artery dissection due to stent implantation for spontaneous coronary artery dissection of left circumflex artery: a case report

2019 ◽  
Vol 3 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Kensuke Matsushita ◽  
Jessica Ristorto ◽  
Olivier Morel ◽  
Patrick Ohlmann
Keyword(s):  
Optical Coherence Tomography ◽  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Percutaneous Coronary ◽  
Intimal Tear

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare disease that predominantly affects woman. Percutaneous coronary intervention (PCI) is recommended only in patients with ongoing ischaemia because it carries a high risk of procedural complications in SCAD patients. Case summary A 51-year-old woman was admitted to our institution owing to severe chest pain. Coronary angiography showed a diffuse narrowing and radiolucent luminal flap which runs parallel to the vessel wall in the proximal left circumflex coronary artery and SCAD was diagnosed. After PCI was undertaken, optical coherence tomography disclosed a circular haematoma at the stent distal segment and an intimal tear at the distal left main coronary artery. A conservative approach was decided owing to patient stability without evidence of ongoing ischaemia and normal coronary flow. Thirty minutes later, the patient started to complain of chest pain with the ST-segment elevation in leads I, aVL, and V2–3. Coronary angiography demonstrated a total occlusion of the second diagonal brunch and double lumen morphology at the proximal-potion of left anterior descending with TIMI2 distal flow suggesting the extension of coronary dissection. Optical coherence tomography imaging revealed that the entry door of the dissection was located where the small intimal tear was found. Percutaneous coronary intervention was successfully performed, and the patient was discharged without any complication. Discussion Although the underlying mechanism of recurrent SCAD remain largely unknown, our case suggests that the residual inlet of the dissection may associate with the extension of the coronary dissection.

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