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CLINICAL STUDIES

Immediate exercise testing of low risk patients with known coronary artery disease presenting to the emergency department with chest pain

^a Division of Cardiovascular Medicine, Department of Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
^b Division of Emergency Medicine, Department of Medicine, University of California, Davis School of Medicine, Sacramento, California, USA

Manuscript received June 15, 1998; revised manuscript received January 25, 1999, accepted February 15, 1999.

Reprint requests and correspondence: Dr. William R. Lewis, 4150 V St., Suite 3500, Sacramento, California 95817
wrlewis{at}ucdavis.edu

OBJECTIVES

The purpose of this study was to demonstrate the safety and utility of immediate exercise treadmill testing (IETT) of low risk patients presenting to the emergency department with known coronary artery disease (CAD).

BACKGROUND

More than 70% of the two million patients admitted to U.S. hospitals annually for suspected acute myocardial infarction (AMI) are found not to have had a cardiac event. We have previously demonstrated the safety and efficacy of IETT of selected low risk patients without known CAD presenting to the emergency department with chest pain. This study extends this approach to selected patients with a history of CAD.

METHODS

One hundred patients evaluated by the chest pain emergency room to rule out AMI underwent IETT using a modified Bruce protocol upon admission to the hospital (median time <1 h).

RESULTS

Twenty-three patients (23%) had positive exercise electrocardiograms (ExECGs); an uncomplicated non–Q wave AMI was diagnosed in two patients. Thirty-eight patients (38%) had negative ExECGs and 39 patients (39%) had nondiagnostic ExECGs. Of these 100 patients, 64 were discharged immediately after IETT, 19 were discharged in less than 24 h after negative serial cardiac enzymes and stable electrocardiograms and 17 were discharged after further evaluation and treatment. There were no complications from exercise testing and no late deaths or AMI during six-month follow-up.

CONCLUSIONS

Immediate exercise treadmill testing of low risk patients with chest pain and known CAD is effective in further stratifying this group into patients who can be safely discharged and those who require hospital admission.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   CPER = chest pain emergency room   ECG = electrocardiogram   ExECG = exercise electrocardiogram   IETT = immediate exercise treadmill testing   MPHR = maximal predicted heart rate

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