0119 : Validity of the discharge diagnosis in patients for whom an acute coronary syndrome was excluded initially. Prospective, observational study over a period of one month with one year follow-up in Rouen University Hospital

Background Chest pain is a common reason for admission to the emergency department (ED). The diagnostic approach is difficult due to the diversity and potential severity of responsible causes. Aims The purpose of this study is to evaluate the appropriateness of discharge diagnosis among patients for whom an acute coronary syndrome (ACS) was excluded during the initial management. Methods This prospective, observational, single-center study was performed during one month in October 2013 in the ED of the University Hospital of Rouen. All patients admitting for chest pain were eligible. Only those who did not have acute coronary syndrome, pulmonary embolism, and aortic dissection were included. The primary endpoint combined cardiovascular death, non-fatal acute coronary syndrome, and revascularization by percutaneous coronary intervention (PCI) or bypass surgery at 12 months. Results Over a period of one month, 372 patients consulted for chest pain at the ED (11.2% of patients). 324 patients were included in this study. The number of patients lost of follow-up at 1 month and 1 year was respectively 18 (5.5%) and 53 (16.2%). The primary end-point occurred in 4 patients (1.23%), including 3 ACS without ST segment elevation requiring PCI in 2 cases and one cardiovascular death. Four non-cardiovascular deaths also occurred. Conclusion The results of this study showed a one-year very low rate of misdiagnosis in chest pain patients initially managed to the ED. Our results are concordant with those previously reported in chest pain units. The author hereby declares no conflict of interest