TY - JOUR
T1 - Evaluation of chest pain in low-risk patients presenting to the emergency department
T2 - The role of immediate exercise testing
AU - Kirk, James D
AU - Turnipseed, Samuel D
AU - Lewis, William R
AU - Amsterdam, Ezra A
PY - 1998
Y1 - 1998
N2 - Study objectives: To determine the safety and utility of immediate exercise testing in the evaluation of low-risk patients presenting to the emergency department with chest pain and its applicability to a heterogeneous population of men and women. Methods: We conducted a prospective study of the safety and utility of immediate exercise testing in low-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, university 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 patients (121 men, 91 women) under- went exercise testing with no adverse effects. Twenty-eight (13%) patients had positive results on exercise ECGs. Twenty-three of the latter had further evaluation that revealed evidence of coronary artery disease in 13 (57%). Fifty-nine percent (125/212) of patients had negative exercise test results and 28% (59/212) had 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 patient population support the safety and utility of immediate exercise testing of low-risk patients who present to the ED.
AB - Study objectives: To determine the safety and utility of immediate exercise testing in the evaluation of low-risk patients presenting to the emergency department with chest pain and its applicability to a heterogeneous population of men and women. Methods: We conducted a prospective study of the safety and utility of immediate exercise testing in low-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, university 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 patients (121 men, 91 women) under- went exercise testing with no adverse effects. Twenty-eight (13%) patients had positive results on exercise ECGs. Twenty-three of the latter had further evaluation that revealed evidence of coronary artery disease in 13 (57%). Fifty-nine percent (125/212) of patients had negative exercise test results and 28% (59/212) had 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 patient population support the safety and utility of immediate exercise testing of low-risk patients who present to the ED.
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U2 - 10.1016/S0196-0644(98)70091-5
DO - 10.1016/S0196-0644(98)70091-5
M3 - Article
C2 - 9656941
AN - SCOPUS:0031808827
VL - 32
SP - 1
EP - 7
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
SN - 0196-0644
IS - 1
ER -