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Purpose While cardiac troponins (C-Tn) are widely used in the emergency room in case of chest pain, there is an increasing rate of prescription of this test by general practitioners (GPs) in outpatients. Limited data are available on the motivations and the issue of C-Tn requested by GPs. We sought to assess the reasons for C-Tn test prescribed by GPs in our community in France, and the management of the positive cases. Methods We retrospectively retrieved all the C-Tn test requests made by GPs to the 2 major laboratories in our community of 250,000 inhabitants, within a period of 4 months. The GPs were contacted by phone to assess their motivations. Results During this period, 306 C-Tn tests were requested by 157 GPs. We excluded 64 cases because of insufficient data. They were comparable to those included in the study in terms of age, gender, and positive test rates. Among the 242 cases studied (median age 70 years, 51% males), 41% had ≥3 coronary risk factors. C-Tn was requested because of chest pain in 202 patients (83%). 71% had atypical pain. The prescription was made in more than 6 and 24 hours after symptom’s onset in 78% and 55% of cases, respectively. ECG was performed before C-Tn test prescription in only 15% of cases. In 92% of cases, C-Tn test was negative. Among the 18 positive cases, 5 (19%) remained at home (3 very old patients, mean age 91 years, and 2 cases considered as false positives). Among the 13 remaining positive cases, 7 were referred directly to cardiologists and 6 to an emergency department. Among these 13 patients, 11 were referred without medical transportation. Only 1 patient was transferred medically directly to the cath lab, 24 hours after chest pain onset. Conclusion Cardiac troponin is mainly requested by GPs to exclude acute coronary syndrome in case of atypical chest pain with delayed consultation. However, the positivity of this test was useless in 1 out of 5 patients since it has not changed their management. While in the majority, the C-Tn tests requested by GPs are negative and avoid hospitalization, the management of patients with positive test is delayed and not secured. [ABSTRACT FROM AUTHOR]

Purpose Despite public campaigns for calling rapidly the emergency phone number in case of chest pain, many patients still delay their call. We sought to determine factors influencing the call delay in case of STEMI. Methods We studied 206 consecutive patients admitted for STEMI. They were classified according to tertiles of delay between symptoms onset and the first call (« early-callers » for 1st & 2nd tertiles, « late-callers » for the 3rd tertile). We compared these 2 groups according to the registry data. We contacted the survivors to obtain further information on socio-economic status and events during symptoms onset. Results The patients (age 64±14 y, 75% males) called on average in 2.5±3.5 hours (early-callers 1.6±1.8 vs. 4.4±5.0 for late-callers). In multivariate analysis, the following factors were significantly associated with late call: age (OR=1.03, 95%CI: 1.00-1.05), living >30 min. from cath lab (OR=2.8, 1.1-7.1), symptoms onset between 00:00-05:59 am (OR=2.3, 1.1-4.8) and first call to the family physician (OR=1.9, 1.8-3.6). The respondents to interview did not differ from others regarding age and call delay. Main variables during interview are compared between in the 2 groups in Figure. In a second model using interview variables, following factors were associated with late call, adjusted for age and sex: symptoms onset between 00:00-05:59 am (OR=3.8, 1.00-14.5), self-medication (OR=7.7, 2.2-27.0), mild pain (visual scale <6: OR=10.0, 2.94-33.3) and symptoms onset out of home (OR=6.7, 1.04-50.0). We found no association between call delay and education level, occupation, cardiovascular risk factors and history. Conclusions Delayed call for STEMI is multifactorial. Our data are useful to target the population and highlight messages in future campaigns. Abstract 0227 – Figure: Comparison of early vs. late callers [ABSTRACT FROM AUTHOR]

Introduction Chest pain is a frequent cause of admission to the emergency department (ED). The diagnosis and medical care of acute coronary syndrome (ACS) with ST-segment elevation (ST+ ACS) are more standardized than non ST-segment elevation ACS (NST ACS). There is very few series on patients classified as low ACS-diagnosis probability. We aimed to assess the 1-year outcome of patients admitted for chest pain in ED and discharged with low risk of ACS. Methods This restrospective study included all patients admitted in the ED of University Hospital Center of Limoges between January and March 2013 for chest pain, without ST-segment elevation and normal troponin level. Patients’ characteristics and initial diagnosis were collected in ED records. Final diagnosis was obtained by phone one year later, from general practitioners or alternatively directly from the patients themselves. Results Among the 244 patients studied, 38 (15.6%) were lost during follow-up. Mean age was 50±17 years, 58% being males. Among the 41% of cases in whom the initial diagnosis (i.e. ED discharge) was modified during follow-up, 9% (n=8) were diagnosed with coronary disease, and 38% (n=32) with panic attack. Major adverse cardiac events rate was 2.4% (n=5) in the whole population, and 60% of them were directly discharged to home. In the ED, the detection of a cardiovascular etiology of chest pain was accurate with good specificity (96%) but lower sensibility (61%). Of note, the rate of false negative patients was 8.5%. Conclusion Low probability NST SCA diagnosis is complex in the ED and may frequently lead to erroneous diagnosis associated with therapeutic delay. Nevertheless, cardiac disorders are uncommonly misdiagnosed. A systematic, individualized and close monitoring after ED discharge is mandatory. [ABSTRACT FROM AUTHOR]