Utility and safety of immediate exercise testing of low-risk patients admitted to the hospital with acute chest pain

It is common practice to hospitalize patients with chest pain for a period of observation and to perform further diagnostic evaluation such as exercis e treadmill testing (ETT) once acute myocardial infarction (AMI) has been e xcluded. This study evaluates the safety and efficacy of immediate ETT for patients admitted to the hospital with acute chest pain. One hundred and ni nety non-consecutive low-risk patients admitted to the hospital from emerge ncy department with acute chest pain underwent ETT using Bruce protocol imm ediately on admission to the hospital (median time 165+30 min). Fifty-seven (30%) patients had positive exercise electrocardiograms, 44 (77.2%) of who m had significant coronary narrowing by angiography. An uncomplicated anter ior non-Q-wave AMI was diagnosed in one patient. One hundred and eleven (58 .4% patients had negative and 22 (11.6%) patients had non-diagnostic exerci se electrocardiograms. Of these 133 patients, 86 (64.7%) were discharged im mediately after ETT, 19 (14.3%) were discharged within 24 h, and 28 (21%) w ere discharged after 24 h of observation. There were no complications from ETT. During the 17 +/- 6 months follow-up no patients died, and only eight (7.2%) patients with negative ETT experienced a major cardiac event tone AM I and seven angina). In conclusion, our results suggest that immediate ETT of low-risk patients with chest pain who are at sufficient risk to be desig nated for hospital admission, is effective in further stratifying this grou p into those who can be safety discharged immediately and those who require hospitalization. (C) 2000 Elsevier Science Ireland Ltd. All rights reserve d.