EVALUATION OF CHEST PAIN IN LOW-RISK PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT - THE ROLE OF IMMEDIATE EXERCISE TESTING

Study objectives: To determine the safety and utility of immediate exe rcise testing in the evaluation of low-risk patients presenting to the emergency department with chest pain and its applicability to a heter ogeneous population of men and women. Methods: We conducted a prospect ive study of the safety and utility of immediate exercise testing in l ow-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, univ ersity 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 pa tients (121 men, 91 women) underwent exercise testing with no adverse effects. Twenty-eight(13%) patients had positive results on exercise E CGs. Twenty-three of the latter had further evaluation that revealed e vidence of coronary artery disease in 13(57%). Fifty-nine percent(125/ 212) of patients had negative exercise test results and 28% (59/212) h ad 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 p atient population support the safety and utility of immediate exercise testing of low-risk patients who present to the ED.