Risk stratification of patients with chest pain who have an unscheduled revisit to the emergency department

Int J Cardiol. 2023 Jul 15;383:96-101. doi: 10.1016/j.ijcard.2023.04.043. Epub 2023 Apr 26.


Aims: Acute cardiovascular (CV) emergencies are critical conditions that require urgent attention in the emergency department (ED). Failure to make a timely diagnosis may result in unscheduled ED revisits and severe outcomes. Therefore, this study aimed to investigate the risk factors associated with potentially missed acute CV emergencies.

Methods and results: This retrospective study enrolled adult patients who presented with chest pain and returned to the ED within 72 h. Demographic information, pre-existing medical conditions, chief complaints, triage level and vital signs, electrocardiography (ECG) reports, and laboratory data were collected from medical charts by independent physicians. The primary outcome was the diagnosis of acute CV diseases, including ACS, pulmonary embolism, unstable arrhythmia, acute decompensated heart failure, and aortic dissection. Multivariable logistic regression was used to analyze the association between variables and acute CV emergencies. A total of 453 eligible patients were included, with 60 (13.2%) patients diagnosed as acute CV emergencies at the ED revisit. Risk factors for acute CV emergencies included male gender (adjusted odds ratio [aOR] = 2.71, 95% confidence interval [CI] = 1.17-6.25), abnormal ECG rhythm (aOR = 10.33, 95% CI = 4.68-22.83), and abnormal changes in high sensitivity Troponin-T (hs-cTnT) during sequential follow-up (aOR = 6.52, 95% CI = 2.19-19.45).

Conclusions: Male gender, abnormal ECG rhythm, and a significant increase in sequential follow-up hs-cTnT levels were identified as significant risk factors for acute CV emergencies. ED physicians should recognize these high-risk patients with chest pain to prevent misdiagnosis and potential severe complications.

Keywords: Cardiac enzyme; Chest pain; Emergency department; Revisit; Troponin.

MeSH terms

  • Adult
  • Biomarkers
  • Chest Pain / diagnosis
  • Chest Pain / epidemiology
  • Chest Pain / etiology
  • Electrocardiography / methods
  • Emergencies*
  • Emergency Service, Hospital*
  • Humans
  • Male
  • Retrospective Studies
  • Risk Assessment / methods
  • Troponin T


  • Troponin T
  • Biomarkers