Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features

Scott, Adam C., Bilesky, Jennifer, Lamanna, Arvin, Cullen, Louise, Brown, Anthony F. T., Denaro, Charles and Parsonage, William (2014) Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features. EMA - Emergency Medicine Australasia, 26 2: 170-176. doi:10.1111/1742-6723.12222

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Author Scott, Adam C.
Bilesky, Jennifer
Lamanna, Arvin
Cullen, Louise
Brown, Anthony F. T.
Denaro, Charles
Parsonage, William
Title Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features
Journal name EMA - Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6723
1742-6731
Publication date 2014-04-01
Year available 2014
Sub-type Article (original research)
DOI 10.1111/1742-6723.12222
Open Access Status Not Open Access
Volume 26
Issue 2
Start page 170
End page 176
Total pages 7
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Objective
National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated.

Methods
A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary syndrome. Chart review was completed on patients with positive stress tests.

Results
The 3987 patients with suspected intermediate risk acute coronary syndrome underwent exercise stress testing. One thousand and twenty-seven (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of these 1027 patients had a positive exercise stress test (0.4% incidence of positive exercise stress testing). Of those, three patients had subsequent non-invasive functional testing that yielded a negative result. One patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079–0.115%) (one of 1027 patients).

Conclusions
Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.
Keyword Acute coronary syndrome
Chest pain
Emergency department
Exercise stress test
Major adverse cardiac event
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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