Sekhri N et al. (2006) How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients. Heart [doi: 10.1136/hrt.2006.090894]

No-appointment 'rapid access' chest pain clinics are increasingly being used for the identification of first cases of angina, a primary manifestation of coronary heart disease. The success of these clinics in correctly differentiating between patients with angina—who require further cardiac assessment and treatment—and those with noncardiac chest pain has been investigated in a large-scale study performed in six UK centers.

Sekhri and co-workers in London, UK, analyzed data from 8,762 patients with new, undifferentiated chest pain referred from primary care to rapid access chest pain facilities. They found that patients diagnosed with angina in the rapid access centers (27% of referred patients) had a much higher risk of death from coronary heart disease or nonfatal acute coronary syndromes than patients diagnosed with noncardiac chest pain, and a higher risk than the general population. Among patients diagnosed with angina, the cumulative mortality resulting from coronary heart disease or acute coronary syndromes was estimated at 8.62% after 1 year, and 16.52% after 3 years, thereby strengthening evidence for a strong relationship between angina and future adverse coronary events.

Tarnishing these positive results, however, was the fact that nearly a third of the primary endpoints analyzed occurred in patients diagnosed with noncardiac chest pain; of these patients, those with diabetes, some Asians, and those with abnormalities on electrocardiography were at particularly high risk. The authors highlight the need for studies aimed at improving diagnostic precision, and for medics to initiate appropriate treatment for the prevention of future coronary events.