Adequacy of an Exercise Test in Excluding Angina on Patients Presenting to the Emergency Department with Chest Pain

Abstract

Background:The clinical utility and cost effectiveness of exercise testing (ET) following evaluation by a cardiologist to exclude angina in patients presenting to the emergency department (ED) with chest pain was evaluated. Methods:Patients presenting to the ED with no apparent cause were evaluated. Of 239 patients presenting to the ED with chest pain without a history of coronary artery disease, 23 underwent sestamibi scanning with 216 undergoing ET. Follow‐up evaluation was performed by telephone. Results:Of 216 ETs, 168 (77.8%) were negative, 24 (11.1%) positive, 24 (11.1%) indeterminate (209 discharged home directly). During follow‐up (mean 20 months: range 5–37) there were three noncardiac deaths (malignancies = two, pneumonia = one) with five patients diagnosed with angina among the 168 with negative tests. Forty‐two patients indicated unscheduled return visits (ED = 15, physician's office = 23, admissions = 4). The present management strategy realized a saving of Canadian (Cdn). $86,585.60 when compared with sestamibi scanning as the primary test. Conclusions: ET following an evaluation by a cardiologist can be used for the initial screening of patients presenting with chest pain to the ED with a high negative predictive accuracy with regard to future coronary events. Nuclear perfusion imaging can be used in a minority of patients where an ET is not feasible. A.N.E. 1999;4(4):408–415