Limited Benefit To Expedited Stress Testing of Chest Pain In ER Patients Interview with:
Alexander Sandhu, MD MS

Cardiology Fellow
Stanford University What is the background for this study? What are the main findings?

Response: Millions of patients present to the emergency department with chest pain but most do not have lab or EKG findings that indicate the patient is having a heart attack. In patients without signs of a heart attack, stress testing is frequently used to determine the need for further workup and treatment. However, there is limited evidence regarding the benefit of stress testing in these patients.

We evaluated how cardiac testing – stress testing and coronary angiography – in these low-risk patients was associated with clinical outcomes. We used a statistical approach that took advantage of the fact that testing is more available on weekdays than weekends. We found that testing was associated with more angiography and revascularization (coronary stenting or coronary artery bypass surgery) but was not associated with a reduction in future heart attacks. What should clinicians and patients take away from your report?

Response: This analysis further emphasizes the limited evidence of benefit for the current standard practice of expedited stress testing in patients who present with chest pain who are not having an acute heart attack. This suggests that shared decision-making considering the benefits and risks of early stress testing is a viable alternative to routine testing. Of importance, this was an observational, non-randomized study that may be subject to residual confounding. What recommendations do you have for future research as a result of this study?

Response: Given the importance of this clinical question, our findings  emphasize the need for a randomized controlled trial evaluating early stress testing in patients who present to the emergency department with acute chest pain. Additional research is also needed to evaluate if specific subgroups may benefit from early stress testing.

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Sandhu AT, Heidenreich PA, Bhattacharya J, Bundorf MK. Cardiovascular Testing and Clinical Outcomes in Emergency Department Patients With Chest Pain. JAMA Intern Med. Published online June 26, 2017. doi:10.1001/jamainternmed.2017.2432

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


Last Updated on June 27, 2017 by Marie Benz MD FAAD