Comparing Representation Rates After Multi-Modality Cardiac Investigations in a 4 Year Cohort of Repeat Presenters with Intermediate Risk Chest Pain

Background: Presentation to hospital with chest pain is a major burden on the healthcare system with a large amount of time and resources spent on excluding severe coronary artery disease, especially in repeat presenters. Method: All troponin negative, intermediate risk chest pain patients presenting to the Royal Brisbane Women's Hospital between 1/1/2012 and 4/3/2016 undergo an exercise stress test (EST) and were audited. The 92 repeat presenters were follow-up through the Queensland health medical databases for cardiovascular outcome and impact of various investigations on representation over an average 33 month period. Results: There was an average of 9 months between presentations. Only 1 patient had a myocardial infarction during follow-up, 3 others underwent PCI. 60.9% presented 1 further time, 12.0% 2 times, 7.6% 3 times, 8.7% 4 times, 3.3% 5 times and 7.6% >5 times. DSE was performed in two patients and both represented at an average of seven months. ESE was performed in 5 patients and all represented at 17 months (average). MPS was performed in 12 patients and 8 represented at 15 months (average). CTCA was performed in 24 patients, 12 represented at 10 months (average). Invasive coronary angiogram was performed in 13 patients, nine represented, including two with PCI at 19 months (average). Conclusion: Repeat presenters tended to represent less often if they underwent a CTCA followed by a MPS then invasive coronary angiogram to exclude significant coronary artery disease. There was a very low incidence of myocardial infarction and revascularisation in this cohort.