title: Diagnostic yield of routine noninvasive cardiovascular testing in low-risk acute chest pain patients.
abstract: Contemporary professional society recommendations for patients presenting to the emergency department with acute chest pain and low clinical risk encourage noninvasive testing for coronary artery disease (CAD) before, or shortly after, discharge from the emergency department. Recent reports indicate that a strategy of universal testing has a low diagnostic yield and may not be necessary. We examined data from a prospective cohort of patients who underwent evaluation of acute chest pain in our chest pain evaluation center (CPEC). Patients presenting with normal initial electrocardiogram and cardiac injury markers were eligible for observation and noninvasive testing for CAD in our CPEC. All patients were asked to participate in the prospective registry. The 213 subjects who consented were young, obese, and predominantly women (mean age 43.8 ± 12.5, mean body mass index of 30.8 ± 7, 64.8% women). Prevalence of diabetes was 10.3% (hypertension 37.1%, hyperlipidemia 17.8%, and current tobacco use 23.5%) Exercise treadmill testing was the primary method of evaluation (n = 104, 49%) followed by computed tomography coronary angiography (n = 58, 27%) and myocardial perfusion imaging (n = 20, 9%). Of 203 patients who underwent testing, 11 had abnormal test results, 4 of whom had obstructive CAD based on invasive coronary angiography. The positive predictive value for obstructive CAD after an abnormal test was 45.5%, and the overall diagnostic yield for obstructive CAD was 2.5%. In conclusion, in patients with acute chest pain evaluated in a CPEC, the yield of routine use of noninvasive testing for CAD was minimal and the positive predictive value of an abnormal test was low.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida. Electronic address: dwinches@ufl.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
authors.affiliation: Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: John
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Shands Hospital at UF Health, Gainesville, Florida.
authors.forename: Carla
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Brandon
authors.initials: B
authors.lastname: Allen
authors.affiliation: Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Thomas
authors.initials: T
authors.lastname: Payton
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of California (Davis) Medical Center, Sacramento, California.
authors.forename: Ezra A
authors.initials: EA
authors.lastname: Amsterdam
mesh_terms: D000208:Acute Disease; D000328:Adult; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D003935:Diagnostic Techniques, Cardiovascular; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors