Long-Term Value of Stress Echocardiography in the Triage of Patients with Atypical Chest Pain Presenting to the Emergency Department.
The purpose of this study was to assess the use of stress echocardiography in the triage of patients presenting to the emergency department with atypical chest pain. We hypothesized that a negative stress echocardiogram would identify patients with a very low risk for future cardiac events, thus reducing the requirement for unnecessary hospitalizations. Stress testing was performed in 105 patients presenting with atypical chest pain, no prior history of coronary artery disease, a nondiagnostic electrocardiogram (ECG), negative serial creatine phosphokinase level at 0 and 4 hours, and baseline normal echocardiograms. Cardiac stress was invoked using an exercise protocol in 75 (71%) patients and intravenous dobutamine in 30 (29%) patients, with ECG and echocardiography results analyzed separately. Cardiac events (myocardial infarction, coronary revascularization, and cardiac death) were noted in 7 (7%) patients with a mean follow-up of 2.8 +/- 1.3 years. Univariate analysis identified five predictors of future cardiac events, but only stress-induced wall motion abnormalities were found to be predictive with multivariate analysis. Kaplan-Meier estimate of cumulative event-free survival for cardiac events at 3 years was 99% for a negative stress echocardiogram (no stress-induced wall motion abnormalities) compared with 95% for stress ECG (< 1-mm ST segment depression). The event-free rate of a positive stress echocardiogram and stress ECG was 25% and 63%, respectively. We conclude that stress echocardiography can be performed safely in patients presenting with atypical chest pain. A negative stress echocardiogram carries an excellent 3-year prognosis and thus identifies patients who may forgo hospital admission and further cardiovascular workup.
Colon
Percy J.
PJ
Departments of Cardiology, Ochsner Medical Foundation, New Orleans, Louisiana.
Cheirif
Jorge
J