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Ann Emerg Med. 1998 Jul;32(1):1-7.

Evaluation of chest pain in low-risk patients presenting to the emergency department: the role of immediate exercise testing.

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1
Department of Internal Medicine, University of California-Davis Medical Center, Sacramento, USA.

Abstract

STUDY OBJECTIVES:

To determine the safety and utility of immediate exercise testing in the evaluation of low-risk patients presenting to the emergency department with chest pain and its applicability to a heterogeneous population of men and women.

METHODS:

We conducted a prospective study of the safety and utility of immediate exercise testing in low-risk patients, as indicated by clinical and ECG criteria. The study group was large, heterogeneous, and included patients with a history of coronary artery disease. The patients were treated at a large, university medical center. Exercise testing (immediate exercise treadmill testing) was performed by internists, and cardiac serum enzyme levels were not measured before the exercise test.

RESULTS:

A total of 212 patients (121 men, 91 women) underwent exercise testing with no adverse effects. Twenty-eight (13%) patients had positive results on exercise ECGs. Twenty-three of the latter had further evaluation that revealed evidence of coronary artery disease in 13 (57%). Fifty-nine percent (125/212) of patients had negative exercise test results and 28% (59/212) had nondiagnostic tests. All patients with negative test results and 93% with nondiagnostic test results were discharged directly from the ED. Thirty-day follow-up was achieved in 201 (95%) patients and revealed no mortality in any of the patients in the three groups. One patient with a positive exercise test result returned to the ED within 30 days with mild congestive heart failure.

CONCLUSION:

Our results in this patient population support the safety and utility of immediate exercise testing of low-risk patients who present to the ED.

PMID:
9656941
[Indexed for MEDLINE]
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