Effectiveness of chest pain pathway in improving clinical outcome among patients with chest pain with ST-elevated and non ST-elevated myocardial infarction
Background: Chest pain is a common presentation of patients at the Emergency Department. The evaluation and clinical management of these patients are highly variable and is one of the biggest challenges of Emergency Physicians due to its diverse causes. Not all patients with Acute Coronary Syndrome are being recognized and appropriately managed, and many people with benign etiology are being admitted unnecessarily. Because of this, a chest pain pathway was developed to classify and improve the management of patients presenting with chest pain. This study aims to determine the impact and effectiveness of chest pain pathway in improving the clinical outcome and quality parameters of patients with ST-elevated and non ST-elevated Myocardial Infarction.
Methods: The study included all adult patients diagnosed with ST-elevated and non ST-elevated Myocardial Infarction using the chest pain pathway. Data on clinical outcome and quality parameters were prospectively gathered, analyzed and described.
Results: Over an 8-month study period, 97 patients were enrolled in the study which included 41 (42%) patients with ST-elevated myocardial infarction and 56 (58%) patients with non-ST elevated myocardial infarction. The clinical outcome showed that 12 (12.4%) were thrombolysed, 88 (90.7%) were discharged and 9 (9.3%) died during admission. The mean time from arrival at the emergency department to the catheterization laboratory for percutaneous intervention was 178 minutes, while the mean time to start of thrombolytic treatment was 117 minutes. The mean length of stay at the coronary care unit after treatment was 6.5 days, while mean length of stay in a regular room was 17 days.
Conclusion: Using the chest pain clinical pathway, assessment of patients with chest pain was easier and management was more efficient. The door to needle time is comparable to literature and guidelines. However, the door to balloon time was longer than what is recommended. There is still room for improvement of the pathway particularly combining it with existing risk scoring systems.