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Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome.

Publication ,  Journal Article
Sun, BC; Laurie, A; Fu, R; Ferencik, M; Shapiro, M; Lindsell, CJ; Diercks, D; Hoekstra, JW; Hollander, JE; Kirk, JD; Peacock, WF; Gibler, WB ...
Published in: Crit Pathw Cardiol
June 2016

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.

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Published In

Crit Pathw Cardiol

DOI

EISSN

1535-2811

Publication Date

June 2016

Volume

15

Issue

2

Start / End Page

60 / 68

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Singapore
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Middle Aged
 

Citation

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Sun, B. C., Laurie, A., Fu, R., Ferencik, M., Shapiro, M., Lindsell, C. J., … Pollack, C. V. (2016). Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome. Crit Pathw Cardiol, 15(2), 60–68. https://doi.org/10.1097/HPC.0000000000000068
Sun, Benjamin C., Amber Laurie, Rongwei Fu, Maros Ferencik, Michael Shapiro, Christopher J. Lindsell, Deborah Diercks, et al. “Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome.Crit Pathw Cardiol 15, no. 2 (June 2016): 60–68. https://doi.org/10.1097/HPC.0000000000000068.
Sun BC, Laurie A, Fu R, Ferencik M, Shapiro M, Lindsell CJ, et al. Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome. Crit Pathw Cardiol. 2016 Jun;15(2):60–8.
Sun, Benjamin C., et al. “Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome.Crit Pathw Cardiol, vol. 15, no. 2, June 2016, pp. 60–68. Pubmed, doi:10.1097/HPC.0000000000000068.
Sun BC, Laurie A, Fu R, Ferencik M, Shapiro M, Lindsell CJ, Diercks D, Hoekstra JW, Hollander JE, Kirk JD, Peacock WF, Gibler WB, Anantharaman V, Pollack CV. Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome. Crit Pathw Cardiol. 2016 Jun;15(2):60–68.

Published In

Crit Pathw Cardiol

DOI

EISSN

1535-2811

Publication Date

June 2016

Volume

15

Issue

2

Start / End Page

60 / 68

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Singapore
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Middle Aged