Open AccessAdequacy of an Exercise Test in Excluding Angina on Patients Presenting to the Emergency Department with Chest Pain
Author(s) -
Senaratne Manohara P.J.,
Carter Debbie,
Irwin Marleen
Publication year - 1999
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/j.1542-474x.1999.tb00231.x
Subject(s) - medicine , emergency department , chest pain , angina , coronary artery disease , pre and post test probability , myocardial perfusion imaging , myocardial infarction , cardiology , emergency medicine , physical therapy , psychiatry
Background: The clinical utility and cost effectiveness of exercise testing (ET) following evaluation by a cardiologist to exclude angina in patients presenting to the emergency department (ED) with chest pain was evaluated. Methods: Patients presenting to the ED with no apparent cause were evaluated. Of 239 patients presenting to the ED with chest pain without a history of coronary artery disease, 23 underwent sestamibi scanning with 216 undergoing ET. Follow‐up evaluation was performed by telephone. Results: Of 216 ETs, 168 (77.8%) were negative, 24 (11.1%) positive, 24 (11.1%) indeterminate (209 discharged home directly). During follow‐up (mean 20 months: range 5–37) there were three noncardiac deaths (malignancies = two, pneumonia = one) with five patients diagnosed with angina among the 168 with negative tests. Forty‐two patients indicated unscheduled return visits (ED = 15, physician's office = 23, admissions = 4). The present management strategy realized a saving of Canadian (Cdn). $86,585.60 when compared with sestamibi scanning as the primary test. Conclusions: ET following an evaluation by a cardiologist can be used for the initial screening of patients presenting with chest pain to the ED with a high negative predictive accuracy with regard to future coronary events. Nuclear perfusion imaging can be used in a minority of patients where an ET is not feasible. A.N.E. 1999;4(4):408–415