title: Usefulness of exercise test in selected patients coming to the emergency department for acute chest pain.
abstract: BACKGROUND
  The management of patients with acute chest pain is a common and difficult challenge for clinicians. In our emergency department (ED) a systematic protocol that involves the use of the exercise test for the management of patients with chest pain of suspected cardiac origin is presently running. The aim of the present study was to evaluate the feasibility of such a test in this setting, in terms of the safety and satisfactory follow-up of these patients discharged home.
  
  
  METHODS
  Patients with chest pain lasting < or = 24 hours, aged > 18 years, without a history of trauma or of any other evident medical cause of chest pain and without high-risk characteristics were included in the present study. These patients, defined as low-risk patients for acute coronary events on admission, were evaluated in the ED area and submitted to serial ECG and blood sampling for the determination of the creatine kinase-MB mass and troponin I serum levels on admission and at 6 and 12 hours after admission. A symptom-limited maximal exercise was performed in the patients with a negative clinical observation and typical chest pain or atypical chest pain but multiple coronary risk factors.
  
  
  RESULTS
  In the year 2000, 1370 patients were evaluated in the ED for chest pain. In 150 (11%) an exercise test was performed. The test was positive in 24 patients (16%). The criteria for a positive test were only clinical in 3 patients, only ECG in 13 patients, and both in 8 patients. Inconclusive tests were observed in 27 patients (18%) and the test was negative in 99 patients (66%). There were no complications during the exercise test. At a median follow-up of 237 days (range 11-443 days), 11 clinical events were recorded (4 acute coronary syndromes and 7 revascularization procedures). Patients with a non-negative exercise test had a significantly shorter event-free survival (p < 0.005).
  
  
  CONCLUSIONS
  The exercise test performed in selected patients coming to the ED with acute chest pain is safe and useful for further risk assessment.
authors.affiliation: Cardiology Unit, S. Maria degli Angeli Hospital, Pordenone, Italy. francomacor@virgilio.it
authors.forename: Franco
authors.initials: F
authors.lastname: Macor
authors.forename: Matteo
authors.initials: M
authors.lastname: Cassin
authors.forename: Cristina
authors.initials: C
authors.lastname: Pitzorno
authors.forename: Erica
authors.initials: E
authors.lastname: Dall'Armellina
authors.forename: Elisa
authors.initials: E
authors.lastname: Carniel
authors.forename: Fortunato
authors.initials: F
authors.lastname: Marcianò
authors.forename: Ermanno
authors.initials: E
authors.lastname: Dametto
authors.forename: Sandro
authors.initials: S
authors.lastname: Bitto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martin
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cervesato
authors.forename: Claudio
authors.initials: C
authors.lastname: Burelli
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
mesh_terms: D000208:Acute Disease; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010343:Patient Admission; D018579:Patient Selection; D013997:Time Factors; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome