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- Title
Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features.
- Authors
Scott, Adam C; Bilesky, Jennifer; Lamanna, Arvin; Cullen, Louise; FT Brown, Anthony; Denaro, Charles; Parsonage, William
- Abstract
Objective National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated. Methods A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary syndrome. Chart review was completed on patients with positive stress tests. Results The 3987 patients with suspected intermediate risk acute coronary syndrome underwent exercise stress testing. One thousand and twenty-seven (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of these 1027 patients had a positive exercise stress test (0.4% incidence of positive exercise stress testing). Of those, three patients had subsequent non-invasive functional testing that yielded a negative result. One patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079-0.115%) (one of 1027 patients). Conclusions Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.
- Subjects
AUSTRALIA; ACUTE coronary syndrome; AGE distribution; CARDIOPULMONARY system; CHEST pain; CONFIDENCE intervals; EXERCISE tests; SCIENTIFIC observation; RISK assessment; RETROSPECTIVE studies; DIAGNOSIS
- Publication
Emergency Medicine Australasia, 2014, Vol 26, Issue 2, p170
- ISSN
1742-6731
- Publication type
Article
- DOI
10.1111/1742-6723.12222