Stress testing in young low-risk patients with potential acute coronary syndromes.
Publication/Presentation Date
6-1-2012
Abstract
OBJECTIVE: Young patients are at low risk for an acute coronary syndrome (ACS); however, many of these patients still enter a "rule-out ACS" pathway and receive stress testing. We hypothesized that stress testing in patients younger than 40 years without known coronary disease will not identify patients at high risk for 30-day adverse cardiovascular events.
METHODS: We conducted a cohort study of patients younger than 40 years evaluated in the emergency department for potential ACS. Patients were excluded if they used cocaine, had known cardiac disease, or had an abnormal electrocardiogram. Patients were followed up in-house; follow-up was performed by direct telephone contact and medical record review. The main outcome was a composite of death, acute myocardial infarction (AMI), and revascularization at 30 days. Comparisons between patients with and without stress testing were done using χ2 or t test, as appropriate; 95% confidence intervals were reported for the main outcomes.
RESULTS: Of 8816 patient visits, 1144 patients met inclusion criteria. Within 30 days, 82 patients (7.2%) received stress testing, 2 of whom led to cardiac catheterization. Death (n=2), AMI (n=3), and revascularization (n=1) were not different between patients who did and did not receive stress testing (2.4% [0.2%-8.5%] vs 0.4% [0.1%-1.0%]).
CONCLUSION: The 30-day cardiovascular complication rate is not different between young patients without known heart disease who do and do not receive stress testing when they present with symptoms of a potential ACS. Testing of young patients at low risk for disease should be reconsidered.
Volume
30
Issue
5
First Page
639
Last Page
642
ISSN
1532-8171
Published In/Presented At
Hamilton, B., Shofer, F. S., Walsh, K. M., Decker, C. S., Calderone, M., Le, J. A., & Hollander, J. E. (2012). Stress testing in young low-risk patients with potential acute coronary syndromes. The American journal of emergency medicine, 30(5), 639–642. https://doi.org/10.1016/j.ajem.2011.02.036
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
21530134
Department(s)
Administration and Leadership
Document Type
Article