Immediate Exercise Testing to Evaluate Low-Risk Patients Presenting to the Emergency Department with Chest Pain.

Quantifying Patient-Physician Communication and Perceptions of Risk During Admissions for Possible Acute Coronary Syndromes

“…5,6 In the setting of negative initial biomarker results and a nonischemic ECG result, the 30-day risk profile of ED patients with chest pain is favorable. [7][8][9] Most patients can be risk stratified to a less than 1% chance of adverse event, although no patients can be stratified to zero risk.…”

Coronary computed tomography angiography for the assessment of chest pain: current status and future directions

“…However these functional tests are limited in their utilization for early triage due to the inappropriateness of performing them before confirmation of serial negative cardiac biomarkers and by the frequency of non-diagnostic tests. Although they provide additive risk stratification information, their diagnostic accuracy for the detection of obstructive CAD is limited, leading to unnecessary ICAs in 33-44 % of patients with suspected ACS [63,64].…”

Utility of Routine Exercise Stress Testing among Intermediate Risk Chest Pain Patients Attending an Emergency Department

“…Therefore, the lengthy assessment process may yield equivocal results or place the patient at unnecessary risk, by necessitating further invasive investigations such as coronary angiography. A number of studies also have found that EST adds limited diagnostic information beyond clinical data and biomarkers [5], particularly for younger individuals [9].…”

“…Exercise stress testing is the most commonly used modality of provocative testing for a patient with a normal ECG who is not taking digoxin and who is without physical limitations [4]. Numerous studies from the United States have found that a negative exercise stress test (EST) is accurate, safe and cost-effective in excluding ACS in low risk patients [5][6][7]. However, such studies also report low positive predictive values [7] and high rates of indeterminate tests (around 25%) [3,8].…”