title: What is the Yield of Testing for Coronary Artery Disease after an Emergency Department Attendance with Chest Pain?
abstract: BACKGROUND
  Guidelines recommend testing for coronary artery disease (CAD) for emergency department (ED) patients with a negative workup for acute coronary syndrome (ACS). The rationale is that, although myocardial infarction has been ruled out, the presentation could still indicate cardiac ischaemia. Evidence supporting this recommendation is weak.
  
  
  METHODS
  Planned sub-study of prospective cohort study of ED chest pain patients with a negative ACS workup who were discharged. Primary outcome of interest was occurrence of major adverse cardiac events (MACE) within 30 days. Secondary outcomes were rate of combined MACE or revascularisation and rates and outcome of referral for CAD testing. Analyses were descriptive.
  
  
  RESULTS
  742 patients were included; median age 56, 52% male. There were two MACE within 30 days (0.3%; 95% CI 0.07-1%). Two patients had revascularisation without ACS - combined MACE or revascularisation rate 0.5% (95% CI 0.2-1.4%). Seventy-five per cent of patients with adverse events had previously known CAD. There was no statistically significant difference in outcome between those referred for testing and those who were not. Age, TIMI score 0-1 and absence of known CAD performed well as potential discriminators for selective testing.
  
  
  CONCLUSIONS
  In our study the rate of MACE within 30 days was very low, coronary intervention was rare and most patients with MACE or revascularisation had previously known CAD. For young patients, those without known CAD and those with a low TIMI score, the risk of clinically significant CAD appears to be very low. It adds to the case for abandoning routine testing for CAD.
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research at Western Health and The University of Melbourne, Melbourne, Vic., Australia. Electronic address: anne-maree.kelly@wh.org.au.
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research at Western Health and The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Klim
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
keywords: Chest pain; Emergency Department; Non-invasive testing