Immediate exercise testing of low risk patients with known coronary arterydisease presenting to the emergency department with chest pain

OBJECTIVES The purpose of this study was to demonstrate the safety and util ity of immediate exercise treadmill testing (IETT) of low risk patients pre senting to the emergency department with known coronary artery disease (CAD ). BACKGROUND More than 70% of the two million patients admitted to U.S. hospi tals annually for suspected acute myocardial infarction (AMI) are found not to have had a cardiac event. We have previously demonstrated the safety an d efficacy of IETT of selected low risk patients without known CAD presenti ng to the emergency department with chest pain. This study extends this app roach to selected patients with a history of CAD. METHODS One hundred patients evaluated by the chest pain emergency room to rule out AMI underwent IETT using a modified Bruce protocol upon admission to the hospital (median time <1 h). RESULTS Twenty-three patients (23%) had positive exercise electrocardiogram s (ExECGs); an uncomplicated non-Q wave AMI was diagnosed in two patients T hirty-eight patients (38%) had negative ExECGs and 39 patients (39%) had no ndiagnostic ExECGs. Of these 100 patients, 64 were discharged immediately a fter IETT, 19 were discharged in less than 24 h after negative serial cardi ac enzymes and stable electrocardiograms and 17 were discharged after furth er evaluation and treatment. There were no complications from exercise test ing and no late deaths or AMI during six-month follow-up. CONCLUSIONS Immediate exercise treadmill testing of low risk patients with chest pain and known CAD is effective in further stratifying this group int o patients who can be safely discharged and those who require hospital admi ssion. (C) 1999 by the American College of Cardiology.