The use of exercise stress testing for the management of low-risk patients with chest pain

ObjectiveThis retrospective study assessed the contribution of exercise stress testing (EST) in the evaluation of patients with low risk for coronary heart disease who presented to the emergency department (ED) with chest pain.Basic ProceduresThe study included 175 patients who presented to the ED with chest pain and underwent EST between January 1, 2005, and November 30, 2006.Main FindingsAfter the EST, 113 patients were discharged, and 62 were admitted. Exercise stress testing's positive predictive value for coronary artery disease among admitted patients was 35.7%, and sensitivity was 95.2%.Exercise stress testing's negative predictive value among discharged patients was 99.1%. None of the 113 discharged patients returned to the ED for cardiac reasons during the 30-day follow-up period.Principal ConclusionA chest pain unit or a parallel facility for evaluating patients with chest pain and with low risk for active coronary disease is necessary for detecting low-risk patients who eventually need cardiac intervention.