The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department

Abstract

In a chest pain population risk stratified with HEART, exercise testing has only a modest contribution to clinical decision making. 50 % of all tests are non-conclusive, with high rates of false positive tests in all three risk groups. In intermediate-risk patients, negative exercise tests may contribute to the exclusion of disease. Clinicians should rather go for sensitive tests, in particular in patients with low HEART scores.

Prevalence of Obstructive Coronary Artery Disease in Ambulatory Patients with Stable Angina Pectoris

“…We observed a high incidence of diabetes mellitus, arterial hypertension, dyslipidemia and smoking in patients included in this study. An exercise or pharmacologic stress test was performed in a part of the patients, but not all of them resulted in a pathological positive result as shown previously [22]. Nevertheless, the number of AP attacks was higher in this study compared to other observational studies [23,24].…”

The value of predischarge exercise ECG testing in chest pain patients in the era of high-sensitivity troponins

“…This is comparable to earlier studies showing no mortality, both at short and at long-term follow-up. 7,9,15,20 In addition, we found no significant differences in mortality or the incidence of MI between patients with negative and positive test results at 90 and 365 days of follow-up. Even though we cannot exclude the possibility of some prognostic impact of variations in coronary revascularisation rates between these cohorts, these data suggest that routine exercise ECG testing before discharge is an excessive strategy in this population.…”

“…7,20 The slight variation in results between studies is probably attributable to differences in patient selection. 8,9,15 Prior exercise ECG test studies show a high proportion of false positive tests. 4,8 In this study only 45 of 94 (47.9%) of the patients with a positive test performed a coronary angiography in hospital and 28 of 94 (29.8%) of the patients were revascularised before discharge.…”

“…7,20 The slight variation in results between studies is probably attributable to differences in patient selection. 8,9,15…”

“…12 Recent studies suggest that chest pain patients evaluated in the ED, in whom MI has been ruled out, have a very low risk of future adverse cardiac events or death, regardless of whether or not they are admitted for further testing. 13,14 Exercise ECG testing has also been suggested to be less useful due to a high proportion of inconclusive and false positive test results, 14,15 and other stress test modalities, such as myocardial scintigraphy and stress echocardiography, are preferred. 12 This raises the issue as to whether the exercise ECG test is an obsolete method leading to unnecessary non-invasive and invasive testing in this population.…”