TY - JOUR
T1 - Association of early stress testing with outcomes for emergency department evaluation of suspected acute coronary syndrome
AU - Sun, Benjamin C.
AU - Laurie, Amber
AU - Fu, Rongwei
AU - Ferencik, Maros
AU - Shapiro, Michael
AU - Lindsell, Christopher J.
AU - Diercks, Deborah
AU - Hoekstra, James W.
AU - Hollander, Judd E.
AU - Douglas Kirk, J.
AU - Frank Peacock, W.
AU - Brian Gibler, W.
AU - Anantharaman, Venkataraman
AU - Pollack, Charles V.
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (eD) evaluation for suspected acute coronary syndrome (acS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. Methods: We analyzed prospectively collected data from 9 eDs on patients with suspected acS, 1999-2001. We excluded patients with an eD diagnosis of acS. the primary outcome was 30-day major adverse cardiac events (Maces), including all-cause death, acute myocardial infarction, and revascularization. We used the Heart score to determine pretest acS risk (low, intermediate, and high). to mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores. Results: Of 7127 potentially eligible patients, 895 (13%) received early stress testing. the analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. the overall 30-day Mace rate in both the source and analytic population was 3%. there were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). there was no association between early stress testing and 30-day Mace [odds ratio, 1.0; 95% confidence interval (ci), 0.6-1.7]. there was no effect modification by pretest risk (low: odds ratio, 1.0; 95% ci, 0.2-3.7; intermediate: 1.2; 95% ci, 0.6-2.6; high: 0.4; 95% ci, 0.1-1.6). Conclusions: early stress testing is not associated with reduced Mace in patients evaluated for suspected acS. early stress testing may have limited value in populations with low Mace rate.
AB - Background: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (eD) evaluation for suspected acute coronary syndrome (acS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. Methods: We analyzed prospectively collected data from 9 eDs on patients with suspected acS, 1999-2001. We excluded patients with an eD diagnosis of acS. the primary outcome was 30-day major adverse cardiac events (Maces), including all-cause death, acute myocardial infarction, and revascularization. We used the Heart score to determine pretest acS risk (low, intermediate, and high). to mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores. Results: Of 7127 potentially eligible patients, 895 (13%) received early stress testing. the analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. the overall 30-day Mace rate in both the source and analytic population was 3%. there were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). there was no association between early stress testing and 30-day Mace [odds ratio, 1.0; 95% confidence interval (ci), 0.6-1.7]. there was no effect modification by pretest risk (low: odds ratio, 1.0; 95% ci, 0.2-3.7; intermediate: 1.2; 95% ci, 0.6-2.6; high: 0.4; 95% ci, 0.1-1.6). Conclusions: early stress testing is not associated with reduced Mace in patients evaluated for suspected acS. early stress testing may have limited value in populations with low Mace rate.
KW - Chest Pain
KW - Emergency department
KW - Stress test
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U2 - 10.1097/HPc.0000000000000068
DO - 10.1097/HPc.0000000000000068
M3 - Article
C2 - 27183256
AN - SCOPUS:84971283695
SN - 1535-282X
VL - 15
SP - 60
EP - 68
JO - Critical pathways in cardiology
JF - Critical pathways in cardiology
IS - 2
ER -