ASSESSMENT OF COST-EFFECTIVENESS OF SEVERAL STRATEGIES OF EARLY DIAGNOSIS IN PATIENTS WITH ACUTE CHEST PAIN AND NON CONCLUSIVE ELECTROCARDIOGRAM (ASSENCE STUDY)

BADANO L. – DESIDERI A. – *PETTINATI G.- *PORTONE F. and ASSENCE STUDY WORKING GROUP

*OSPEDALE “F.FERRARI” – CASARANO

OSPEDALE S.MARIA MISERICORDIA – UDINE

Atti 2nd International Congress of Mediterranean Electrophysiology (Cairo, 20 - 23 september 2001)

Emergency Room evaluation of patients with acute chest pain syndromes and non diagnostic ECG is a challenge for the physician. Indeed in this time of financial contrains physicians are under pressure to reduce frequency, intensity and, most important, length of hospital stay. It has to be noticed that consequences of inappropriate Emergency Room discharge of patients with myocardial ischemia may be serious with up to 8% the patients exeperiencing myocardial infarction within 48 hours. Conservative approaches, like an observational period in Emergency Department has strong drawbacks and are very exepensive. The ASSENCE study is intended to compare accelerated- diagnostic protocol strategies like Dobutamine-Atropine Stress Echocardiography (DASE) and electrocardiographic exercise testing (EET) within 18 hours from pain onset, with the conventional in-hospital observation period for patients with acute chest pain without a conclusive electrocardiogram (ECG).

MATERIALS AND METHOD

314 Patients (mean age 53 years, male gender 57%)  was randomized by 10 partecipating Istitutions from 6 countries: Croatia, Greece, Iran, Italy, Lithuania, Turkey.

Inclusion criteria was: Unexplained chest pain in the last 24 hrs, EKG non-conclusive for acute myocardial ischemia, age > 30 years, CK enzymes and Troponin negative after 6 hrs from symptom onset, Pts. Able to perform an EKG exercise test. All patients was randomized at three group DASE, EET, Clinical observation. Follow-up of all patients was 2 months by periodical visit.

RESULTS

310 Patients concluded the Study, 126 DASE, 89 EET, 95 Clinical observation. 71% Of patients has pain on admission, 75% has last pain attack 0-6 hours.

Discharge Diagnosis was Ischemic Chest Pain 38%, Acute Myocardial Infarction 4%, Non-ischemic Chest Pain 58%.

No event during follow-up, no AMI, no Death, no PTCA, no CABG.

CONCLUSION

ASSENCE Study demonstred that an accelerated protocol using aggressive strategies /DASE, EET, Troponin) about early diagnosis, is very safe and effective on patients with acute chest pain without a conclusive electrocardiogram.