Usefulness of exercise test in selected patients coming to the emergency department for acute chest pain.
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.
Macor
Franco
F
Cardiology Unit, S. Maria degli Angeli Hospital, Pordenone, Italy. francomacor@virgilio.it
Cassin
Matteo
M
Pitzorno
Cristina
C
Dall'Armellina
Erica
E
Carniel
Elisa
E
Marcianò
Fortunato
F
Dametto
Ermanno
E
Bitto
Sandro
S
Martin
Giovanni
G
Antonini-Canterin
Francesco
F
Cervesato
Eugenio
E
Burelli
Claudio
C
Nicolosi
Gian Luigi
GL
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