Incidence, management and outcomes of patients with acute chest pain presenting to the emergency departments in China: findings from a prospective multicentre registry

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OBJECTIVES: Early evaluation and treatment of patients with acute chest pain pose a massive challenge to the emergency care system worldwide. This study aims to determine the current burden and early management of acute chest pain presenting to the emergency departments (EDs) in China. DESIGN: The Evaluation and Management of Patients with Acute ChesT pain study is a prospective, multicentre and provincially representative registry of acute chest pain patients in Chinese EDs. SETTING: A stratified random sampling design generated the province representative sample of 21 public hospitals with independent EDs in Shandong, China. Each participating site consecutively enrolled patients for at least 12 months from August 2015 to September 2017. PARTICIPANTS: A total of 8349 adult patients presenting with acute chest pain or suspected acute coronary syndrome (ACS) were included. PRIMARY OUTCOME MEASURES: The annual incidence of ED-assessed acute chest pain was estimated. The aetiology, process of care and 30-day major adverse cardiac events (MACE) of included patients were analysed. RESULTS: The estimated annual incidence of ED-assessed acute chest pain was 96.6 (95% CI 95.9 to 97.3) per 100 000 adults, significantly increasing with age. The mean age of included patients was 63.8 years, with 57.9% males. Prehospital delay was a median of 2.8 (IQR, 1.2-10.3) hours, with 17.9% transported by ambulance. About 75.6% of patients received their first ECG within 10 min. Cardiac troponin was tested in 54.2%, with high-sensitivity cardiac troponin in 24.5% and serial troponins in 5.1% during the ED stay. Most (74.0%) were admitted to the inpatient ward, with a median ED stay of 65.0 (IQR, 27.0-385.0) min. Within 30 days, 6.8% experienced MACE. Among included patients, 62.9% were diagnosed with ACS, with specific management varying by ST-segment elevation status. CONCLUSIONS: China's first regionally representative registry of acute chest pain revealed a lower incidence of ED-assessed cases but a higher proportion of high-risk patients compared with other countries. Gaps persist in aligning emergency management with guidelines. More programmes and policies are needed to enhance the quality of acute chest pain care in China. TRIAL REGISTRATION NUMBER: This study was registered at URL: https://www. CLINICALTRIALS: gov (NCT02536677).

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