Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 12-16 , July 2009

The Limited Utility of Routine Cardiac Stress Testing in Emergency Department Chest Pain Patients Younger Than 40 Years

  • Luke K. Hermann, MD

      Affiliations

    • Department of Emergency Medicine, Division of Emergency Critical Care, Mount Sinai School of Medicine, New York, NY
    • Corresponding Author InformationAddress for correspondence: Luke K. Hermann, MD, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1149, New York, NY 10029
    • ,
  • Scott D. Weingart, MD

      Affiliations

    • Department of Emergency Medicine, Elmhurst Hospital, New York, NY
    • ,
  • W. Lane Duvall, MD

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY
    • ,
  • Milena J. Henzlova, MD

      Affiliations

    • Division of Cardiology, Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY

Received 24 October 2008 ,Revised 12 December 2008 ,Accepted 7 January 2009.

References 

  1. McCraig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2001 Emergency Department Summary (Advance Data From Vital and Health Statistics: No. 335). Hyattsville, MD: National Center for Health Statistics; 2003;
  2. American College of Cardiology/American Heart Association 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2007;50:e1–e157
  3. Einstein AJ, Moser KW, Thompson RC, et al. Radiation dose to patients from cardiac diagnostic imaging. Circulation. 2007;116:1290–1305
  4. Han JH, Lindsell CJ, Storrow AB, et al. EMCREG i*trACS Investigators The role of cardiac risk factor burden in diagnosing acute coronary syndromes in the emergency department setting. Ann Emerg Med. 2007;49:145–152
  5. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163–1170
  6. Kline JA. The pretest probability primer. http://www.pretestconsult.com/site/Primer2_files/frame.htmAccessed December 3, 2008
  7. Gianrossi R, Detrano R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease (A meta-analysis). Circulation. 1989;80:87–98
  8. Fleischmann KE, Hunink MG, Kuntz KM, et al. Exercise echocardiography or exercise SPECT imaging? (a meta-analysis of diagnostic test performance). JAMA. 1998;280:913–920
  9. Apple FS, Wu AH, Mair J, et al. Committee on Standardization of Markers of Cardiac Damage of the IFCC Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clin Chem. 2005;51:810–824
  10. Esteves FP, Sanyal R, Santana CA, et al. Potential impact of noncontrast computed tomography as gatekeeper for myocardial perfusion positron emission tomography in patients admitted to the chest pain unit. Am J Cardiol. 2008;101:149–152

 Supervising editor: Keith A. Marill, MD

 Author contributions: LKH conceived of the study, supervised data collection, and drafted the article. SDW provided significant revisions to the article, including the structure and content of the discussion and conclusions segments. WLD designed and implemented the data collection instrument that provided background patient information. WLD and MJH assisted with revisions to the article. MJH provided access to the results of all cardiac studies. LKH takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online February 23, 2009.

 Reprints not available from the authors.

PII: S0196-0644(09)00008-0

doi: 10.1016/j.annemergmed.2009.01.006

Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 12-16 , July 2009

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