OP-218 : Clinical characteristics of patients with acute coronary syndrome visiting ordinary outpatient clinic

Hiroaki Wakakuri1, Akihiro Tanaka1, Taro Saigusa1, Makoto Suzaki1, Sonoko Kirinoki1, Naoko Onodera1, Takashi Araki2, Hideya Hyodo1, Toshihiko Ohara1, Makoto Kawai2, Masahiro Yasutake1 1Department of General Medicine & Health Science, Nippon Medical School, Tokyo, Japan 2Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
[Background & Aim] ACS (acute coronary syndrome) patients presenting with typical chest pain are commonly referred to cardiologists, admitted to coronary care unit and receive timely coronary revascularization therapy. However, many ACS patients without chest pain initially see generalists and tend to be subjected to delay and/or underuse of optimal treatment. The aim of this study is to clarify the clinical characteristics of ACS patients who visit our outpatient clinic of general medicine. [Method] Forty five consecutive patients diagnosed as having ACS in our department were reviewed in the period between November 1, 2011 and February 28, 2015. We divided the patients into two groups: the ambulance group (n=21) who were carried by ambulance and the walk-in group (n=24) who came on foot. [Results] The ambulance group (age: 67±12, M/F:15/ 6) consisted of 13 ST-segment elevation myocardial infarction (STEMI), 5 non ST-segment elevation myocardial infarction (NSTEMI), 1 recent MI, and 2 unstable angina (UA) patients. The walk-in group (age: 63±13, M/F: 19/ 5) consisted of 10 STEMI, 6 NSTEMI, 6 recent MI, and 2 UA patients. A proportion of ACS patients with no chest pain was higher in the ambulance group than in the walking group (48% vs 38%). The chief complaint of ACS patients with no chest pain in the ambulance group included nausea (n=6), dyspnea (n=3), and cervical pain (n=1). Likewise, patients in the walking group complained nausea (n=5), dyspnea (n=2), headache (n=1), and back pain (n=1). [Conclusion] Generalists should always bear in mind a possibility of ACS, especially when patients are presenting with acute onset of nausea and/or dyspnea, regardless of admission route: by walk-in or by ambulance.
Keywords: acute coronary syndrome, outpatient clinic, no chest pain