The incremental value of stress testing in patients with acute chest pain beyond serial cardiac troponin testing

Aldous, Sally; Richards, A. Mark; Cullen, Louise; Pickering, John W.; Than, Martin

doi:10.1136/emermed-2015-204823

Cited by 16 publications

(4 citation statements)

References 26 publications

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“…Stress Testing Among patients evaluated in the ED who need further testing, exercise ECG is safe with most patients having negative studies and a low risk of ACS. 1,4,10,14-31,54 Stress echocardiography is safe and effective for triage and prompt discharge of patients and is associated with few events among those with normal or low-risk findings over near-term follow-up of up to 6 months. 17,18,36 Prompt stress echocardiography resulted in a reduction in ED and hospital length of stay, compared with CCTA, with similar 2-year MACE rates ( P =0.47).…”

Section: Choosing the Right Pathway With Patient-centric Algorithms F...mentioning

confidence: 99%

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

et al. 2021

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Aim: This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain” provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.

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Section: Choosing the Right Pathway With Patient-centric Algorithms F...mentioning

confidence: 99%

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

et al. 2021

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“…In cases that are more complicated and in individuals who have more comorbid conditions, addition of the other screening modalities is preferable. Recently, there have been occurrences where individuals who have undergone revascularization did undergo ETT and dobutamine stress echo which was able to diagnose up to 4.3% of the individuals having re-stenosis of the vessel (42). It is therefore the diagnostic and prognostic value of the ETT in its different forms that makes it a vital tool in diagnosis of cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of acute coronary syndrome within a year following a negative stress test—a false sense of security: is routine screening any useful?

et al. 2018

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One of the major issues in management of the acute coronary syndrome (ACS) is classification of patients with atypical presentation who have low risk of having a coronary episode at presentation. There have been multiple studies on the stratification of high risk patients and medical management of such cases, however, there is a sub-class of patients who do not fit any category. In this paper, we have looked at the current literature on stratification of patients based on the study tools available and the risk of having a coronary episode during the following year. In our overview, we have found that the current methods in place namely, cardiac stress test and stress echocardiogram have a good prognostic factor in terms of mortality in the next one year and can safely stratify the patients at low risk when correlated with clinical presentation and laboratory studies. However, such data are limited for computerized tomography or magnetic resonant imaging and their application might be limited due to accessibility and cost of studies. Current guidelines for classification of high risk patient do an excellent job and we believe that proper application of stress tests together with other imaging modalities together with laboratory, clinical judgment, and proper use of medical management can help with safe discharge of patients from the emergency department (ED) and reduction of burden from healthcare.

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“…Contraindications to exercise EGG testing in the ED setting include acute myocardial infarction, ongoing unstable angina, uncontrolled cardiac arrhythmias, symptomatic severe aortic stenosis, decompensated heart failure, active endocarditis, acute pulmonary embolism or deep vein thrombosis, acute myocarditis or pericarditis, acute aortic dissection, significant resting hypertension, and inability to exercise [ 55 , 56 ]. ECG stress testing has been used to practically exclude ACS in low-risk populations [ 53 , 57 ]. However, studies also report lower diagnostic accuracy, increased rates of indeterminate testing, and higher rates of false positive tests with exercise ECG testing [ 58 , 59 ].…”

Section: Functional Assessmentmentioning

confidence: 99%

Appropriateness of Cardiovascular Imaging in the Initial Assessment of Possible Acute Coronary Syndrome in the Emergency Department

Vijayakumar¹,

Shah²

2022

Rev. Cardiovasc. Med.

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Patients presenting with chest pain and related symptoms account for over 6 million emergency department (ED) visits in the United States annually. However, less than 5% of these patients are ultimately diagnosed with acute coronary syndrome (ACS). ED clinicians face the diagnostic challenge of promptly identifying and treating these high-risk patients amidst the overwhelming majority of lowerrisk patients for whom further testing and/or treatment is either unnecessary or non-urgent. To assist with and expedite risk stratification and decision-making in this challenging clinical scenario, diagnostic tools like clinical risk scores and high-sensitivity serum biomarkers have been incorporated into care algorithms within the ED. In this narrative review, we discuss how these tools impact the appropriate use of cardiovascular imaging in the initial assessment of patients presenting to the ED with possible ACS.

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The incremental value of stress testing in patients with acute chest pain beyond serial cardiac troponin testing

Abstract: ACTRN1260900028327, ACTRN12611001069943.

Cited by 16 publications

References 26 publications

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Incidence and predictors of acute coronary syndrome within a year following a negative stress test—a false sense of security: is routine screening any useful?

Appropriateness of Cardiovascular Imaging in the Initial Assessment of Possible Acute Coronary Syndrome in the Emergency Department

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