Identification of patients at risk by graded exercise testing in an emergency department chest pain center

The study applied a retrospective follow-up design to determine the prognos tic effect of graded exercise testing (GXT) in patients with low- to modera te-risk chest pain evaluated in an emergency department 9-hour protocol che st pain center (CPC) from January 1, 1993 to August 1, 1996, The cohort of 1,209 patients were followed to the date of death or first adverse cardiac event up to 1 year after CPC admission. Cardiac events were defined as coro nary artery bypass graft, percutaneous transluminal coronary angioplasty, c ardiogenic shock, cardiac-related death, congestive heart failure admission , ventricular tachycardia/ventricular fibrillation arrest, and myocardial i nfarction. Patients with acute ST-segment elevation or depression of >1 mm, positive enzyme (creatine kinase myocardial band) testing, or unstable ang ina during their CPC evaluation were admitted without GXT testing. Statisti cal analysis included chi-square test for complication rates and Cox propor tional-hazards modeling. Nine hundred fifty-eight of 1,209 patients underwe nt GXT testing. Patients with positive, inconclusive, and normal GXTs had c omplication rates of 36.8% (7 of 19), 3.4% (9 of 267), and 1.1% (5 of 456), respectively. After adjusting for age, sex, and race, the relative risk of complication was 38.9 (95% confidence interval 11.7 to 129.6) with a posit ive GXT, and 3.6 (95% confidence interval 1.2 to 10.7) with an inconclusive GXT compared with a normal GXT. The GXT is a good prognostic indicator of adverse cardiac events in low to moderate-risk chest pain in patients evalu ated in an emergency department CPC. (C) 2000 by Excerpta Medico, Inc.