Short-term adverse cardiac events were rare and commonly iatrogenic among adults with chest pain who have two negative findings for serial biomarkers, normal vital signs, and nonischemic electrocardiogram findings, according to a report published online in JAMA Internal Medicine. 


Lead author Michael B. Weinstock, MD, and colleagues analyzed data from 11,230 emergency department visits in which the primary presenting symptom was chest pain, tightness, burning, or pressure and there were negative findings for serial biomarkers.

 The mean age of the study subjects was 58 years, 55% were women, and 44.83% arrived by ambulance. Relevant history included hypertension in 46%, diabetes mellitus in 19.72%, and myocardial infarction in 13.16% of the group. 

The authors found that life-threatening arrhythmia, inpatient ST-segment elevation myocardial infarction, cardiac or respiratory arrest, or death during hospitalization occurred in 0.06% of, or one in every 1,817, patients in their study.


“We wanted to determine the risk to help assess whether this population of patients could safely go home and do further outpatient testing within a day or two,” Dr. Weinstock said in a press release.
 “These data show routine hospital admission is not the best strategy for this group. To me, this says we can think more about what’s best for the patient long term.”