CLINICAL CORRELATES AND PROGNOSTIC-SIGNIFICANCE OF EARLY NEGATIVE EXERCISE TOLERANCE-TEST IN PATIENTS WITH ACUTE CHEST PAIN SEEN IN THE HOSPITAL EMERGENCY DEPARTMENT

An exercise tolerance test (ETT) is often performed to identify patien ts for early discharge after observation For acute chest pain, but the safety of this strategy is unproven, We prospectively studied 276 low -risk patients who underwent an ETT within 48 hours after presentation to the emergency department with acute chest pain, The ETT was consid ered negative if subjects achieved at least stage I at the Bruce proto col and the electrocardiogram showed no evidence of ischemia. There we re no complications associated with ETT performance, The ETT was negat ive in 195 patients (71%); there was no identifiable subsets of patien ts at very low probability of an abnormal test. During the 6-month Fol low-up patients with a negative ETT had fewer additional visits to the emergency department (17% vs 21%, respectively; p < 0.05) and fewer r eadmissions to the hospital (12% vs 17%; p < 0.01) than those with pos itive or inconclusive ETTs. No patient with a negative EST died and on ly 4 patients with a negative ETT experienced a major cardiac event (m yocardial infarction, coronary angioplasty, or bypass) within (4 month s, Among these 4 patients, only 1 had an event within 4 months, In con clusion, our results suggest that ETT can be safely used to identify p atients at low risk of subsequent events. Patients without a clearly n egative test are at increased risk for readmission and cardiac events, and showed be re-evaluated either during the same admission or shortl y after discharge. (C) 1998 by Excerpta Medica, Inc.