No abstract

No abstract

Background: Chest pain is one of the most common presentations to the emergency department. In patients whom coronary artery disease cannot be excluded by clinical assessment non-invasive diagnostic tests are recommended. Method: We retrospectively reviewed the outcomes of consecutive patients who presented with possible ischaemia and underwent exercise electrocardiograph (ETT), stress echocardiography or computed tomography coronary angiogram (CTCA). Results: Of 100 ETTs 10 were equivocal, 72 negative and 18 positive. All 18 had angiograms, 15 of which were positive. Over an average follow-up of 35 months one patient represented with a major adverse cardiac event (MACE) (after negative ETT). Positive predictive value (PPV): 98%, negative predictive value (NPV): 83%. Of 100 stress echocardiograms four were equivocal, 76 negative and 20 positive. Of the 20 positives 19 had angiograms, 13 demonstrating obstructive disease. Over an average followup of 30 months five patients (all negative tests) represented with MACE (PPV 68%, NPV 96%). Of the 100 CTCAs, 32 were positive, 67 negative and one equivocal. 18 patients proceeded to angiogram of which 15 confirmed ischaemic heart disease. Over an average follow-up of 18 months three patients represented with MACE (all had positive CTCAs, two under medical management, one awaiting angiogram) (NPV 100%, PPV 85%). There was two episodes of periprocedural MACE (one post PCI one post CABG). Conclusion: During follow-up patients undergoing noninvasive testing had low rates of MACE and complications from resulting procedures. Comparison between tests cannot be made due to baseline differences in patient groups

No abstract

No abstract