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Utilization of stress testing for low-risk patients with chest discomfort in the emergency department

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The management of patients presenting to an emergency department with chest discomfort at low-risk for acute coronary syndrome represents a common clinical challenge. Such patients are often triaged to chest pain units for monitoring and cardiac stress testing for further risk stratification.

Methods

We conducted a retrospective study of 292 low-risk patients who presented to an emergency department with chest discomfort. We performed physician-adjudicated chart reviews of all patients with positive stress tests to assess downstream testing, subsequent coronary revascularization, and outcomes.

Results

Of the 292 patients, 33 (11.3%) had stress tests positive for ischemia, and 12 (4.1%) underwent diagnostic cardiac catheterization. Of the 292 patients, 4 (1.4%) underwent coronary revascularization that may have resulted in a mortality benefit.

Conclusion

These data suggest a very low yield of detecting clinically significant coronary disease with stress testing low-risk patients with chest discomfort in emergency department chest pain units.

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Abbreviations

ACS:

Acute coronary syndrome

CAD:

Coronary artery disease

EDOU:

Emergency Department Observation Unit

ECG:

Electrocardiogram

MPI:

Myocardial perfusion imaging

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

CABG:

Coronary artery bypass graft

EF:

Ejection fraction

RCA:

Right coronary artery

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Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Sheela Krishnan MD

  2. Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    Rachael Venn MD

  3. Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA

    Daniel M. Blumenthal MD, MBA, Vijeta Bhambhani MS, MPH, Henry Gewirtz MD, Rory B. Weiner MD & Jason H. Wasfy MD, MPhil

  4. Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    John T. Nagurney MD, MPH

Authors
  1. Sheela Krishnan MD
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  2. Rachael Venn MD
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  3. Daniel M. Blumenthal MD, MBA
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  4. Vijeta Bhambhani MS, MPH
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  5. Henry Gewirtz MD
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  6. Rory B. Weiner MD
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  7. John T. Nagurney MD, MPH
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  8. Jason H. Wasfy MD, MPhil
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Corresponding author

Correspondence to Sheela Krishnan MD.

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Author Contributions

Dr. Krishnan and Dr. Wasfy had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure

Dr. Jason H. Wasfy reports a speaking fee (minor) at the Annual Scientific Session of the American Society for Nuclear Cardiology. Sheela Krishnan, Rachael Venn, Daniel M. Blumenthal, Vijeta Bhambhani, Henry Gewirtz, Rory B. Weiner, and John T. Nagurney have no conflicts of interest to disclose.

Additional information

An audio interview was held December 18th, 2017 between the Editor-in-Chief, Ami E. Iskandrian, and Jason Wasfy, co-author of this article. An audio file of the interview is available as an .mp3 download at the article webpage on SpringerLink.com, and can be found by searching for the article title or DOI.

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Dr. Wasfy is supported by a career development award (KL2 TR001100) from the National Institutes of Health through Harvard Catalyst.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 641 kb)

Supplementary material 2 (MP3 13138 kb)

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Krishnan, S., Venn, R., Blumenthal, D.M. et al. Utilization of stress testing for low-risk patients with chest discomfort in the emergency department. J. Nucl. Cardiol. 26, 1642–1646 (2019). https://doi.org/10.1007/s12350-017-1172-9

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  • DOI: https://doi.org/10.1007/s12350-017-1172-9

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