The Incremental Value of Functional Testing for Acute Chest Pain Assessment in the Context of High-sensitivity Troponin T

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Background: Functional testing for acute chest pain assessment is a common practice that has not been re-examined in the era of high-sensitivity cardiac troponin. This population poses a significant analytical dilemma for physicians to achieve accurate diagnosis, balanced against the inherent risks of hospital admission and invasive downstream testing. This single-centre study evaluated outcomes in patients who underwent chest pain assessment, whose initial diagnosis was not consistent with a MI, comparing subsequent functional testing versus no functional testing. Methods: An inverse probability propensity-matched analysis of patients who underwent chest pain assessment in the emergency department and not initially referred for coronary angiography was performed to examine whether functional testing was associated with a lower rate of death or MI at 30 days. Results: In total, 3,101 patients were included. Functional testing was performed in 986 patients, while 2,115 did not undergo functional testing. The quality of propensity matching for covariates was high. The overall event rate of all-cause mortality and MI was low, totalling at five events. There was no significant difference between those who underwent functional testing versus those who did not undergo functional testing. Conclusion: Functional testing is not likely to be associated with a reduced risk of death or MI within 30 days, and provides limited further diagnostic benefit in the acute timeframe in the context of high-sensitivity cardiac troponin testing.