Utility of Physician Selection of Cardiac Tests in a Chest Pain Unit to Exclude Acute Coronary Syndrome Among Patients Without a History of Coronary Artery Disease

• Published in: The American journal of cardiology 2018-04, Vol.121 (7), p.825-829
• Main Authors: Howell, Stacey J., Bui, Jonathan, Thevakumar, Balasingam, Amsterdam, Ezra A.
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Angiography; Cardiovascular disease; Chest; Coronary artery; Coronary artery disease; Coronary vessels; Echocardiography; Electrocardiography; Emergency medical care; Health risks; Heart; Heart diseases; Heart rate; Incidence; Ischemia; Medical imaging; Pain; Patients; Perfusion; Physicians; Risk analysis; Risk factors; Risk groups; Scintigraphy
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.12.030

There are few data on the utility of physician selection of cardiac tests, including no-test, in a chest pain unit (CPU) to rule out acute coronary syndrome in low-risk patients without a history of coronary artery disease. We analyzed consecutive low-risk patients admitted to our CPU between 2012 and 2014 and determined the proportion of patients selected for testing, the type of initial cardiac test selected, and the incidence of major adverse cardiac events (MACEs) at 30 days and 6 months. The study group comprised 619 patients: mean age 57 years (27 to 92), 332 women (54%), and 360 (58%) with multiple cardiac risk factors. Cardiac testing included 283 no-test (46%); 179 exercise treadmill (29%); 113 myocardial perfusion stress scintigraphy (18%);