Distribution of diseases among emergency Chest Pain Center patients from 2018 to 2022: a retrospective analysis from the Chinese Cardiovascular Association Database

Background and purpose: Since the 2015 launch of China’s National Chest Pain Centers Program (NCPCP), over 2,241 Chest Pain Centers (CPCs) have been accredited. However, comprehensive national data on the disease distribution among patients presenting with chest pain remain limited. This study aimed to describe diagnostic patterns in adults presenting to CPCs across China from 2018 to 2022. Methods: We conducted a retrospective analysis using the Chinese Cardiovascular Association (CCA) Database-CPC, including adult patients (≥18 years) presenting between January 1, 2018, and December 31, 2022. Final diagnoses, assigned by cardiologists per guidelines and aligned with International Classification of Diseases, Tenth Revision (ICD-10) codes, were categorized as: (1) acute coronary syndrome (ACS): ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), unstable angina (UA); (2) non-ACS cardiogenic chest pain; and (3) non-cardiogenic chest pain. Demographic variation was assessed using χ 2 tests, standardized mean differences (SMDs). Results: The analysis included 8,145,680 patients (mean age 58.6 ± 16.4 years; 60.8% male) from 2,241 CPCs. Overall, 37.7% were diagnosed with ACS, 29.0% with non-ACS cardiogenic chest pain, and 33.3% with non-cardiogenic chest pain. Among ACS subtypes, UA (15.5%) and STEMI (14.5%) were predominant, while NSTEMI accounted for 7.7%. ACS patients were typically older than those with non-cardiogenic pain (63.7 vs. 50.2 years, SMD = 0.572), with a male predominance (68.4% vs. 57.0%, SMD = 0.182). The proportion of STEMI was over two-fold higher in men than women (18.2% vs. 8.9%; P < 0.001). Diagnostic distribution varied substantially across all subgroups (all P < 0.001), exemplified by the 72.2% prevalence of non-cardiogenic pain in younger adults (18–39 years) and that over 60% of STEMI patients arrived via inter-facility transfer. Conclusions: This nationwide analysis establishes ACS as the principal diagnosis in China’s CPCs, with significant demographic and geographic variations. These findings provide an evidence base for optimizing triage protocols and resource allocation within the CPC network.