The Limited Utility of Routine Cardiac Stress Testing in Emergency Department Chest Pain Patients Younger Than 40 Years
The Limited Utility of Routine Cardiac Stress Testing in Emergency Department Chest Pain Patients Younger Than 40 Years
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DOI：
10.1016/j.annemergmed.2009.01.006
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发表时间：
2009-07-01
影响因子：
6.2
通讯作者：
Henzlova, Milena J.
中科院分区：
文献类型：
--
作者：
Hermann, Luke K.;Weingart, Scott D.;Henzlova, Milena J.
研究目的：本研究旨在评估在急诊科（ED）评估急性冠状动脉综合征的低风险年轻成人（小于40岁）患者中常规激发性心脏试验的效用。方法：这是一项回顾性观察性研究，研究对象是2004年3月至2007年9月在ed胸痛病房评估急性冠状动脉综合征的23至40岁患者。所有患者都进行了一系列心脏生物标志物检测以排除心肌梗死，然后进行了刺激心脏检测以确定心肌缺血的存在。如果患者已知有冠状动脉疾病，心电图显示诊断为心肌梗死或缺血，或自我承认，或可卡因使用检测呈阳性，则排除在研究之外。结果：符合纳入标准的220例患者中，有6例患者（2.7%；95%置信区间为1% ~ 5.8%）压力测试结果阳性。在这6名患者中，4名患者接受了随后的冠状动脉造影，显示没有阻塞性冠状动脉疾病，这表明最初的挑衅性研究是假阳性。其余2例患者未行诊断性血管造影。除去血管造影结果阴性的患者，220例研究患者中只有2例（0.9%；95%置信区间0.1%至3.2%）心肌缺血试验结果阳性。结论：在我们的研究中，年龄小于40岁，非诊断性心电图结果，以及相隔至少6小时的两组心脏生物标志物阴性结果的组合确定了一个真阳性率非常低的患者组。常规压力测试对该患者组的诊断评价作用不大，所有同意进行冠状动脉造影诊断的患者（6例中有4例）均为假阳性。[Ann Emerg Med. 2009;54:12-16]
Study objective: This is a study designed to evaluate the utility of routine provocative cardiac testing in low-risk young adult (younger than 40 years) patients evaluated for an acute coronary syndrome in an emergency department (ED) setting.Methods: This was a retrospective observational study of patients aged 23 to 40 years who were evaluated for acute coronary syndrome in an ED-based chest pain unit from March 2004 to September 2007. All patients had serial cardiac biomarker testing to rule out myocardial infarction and then underwent provocative cardiac testing to identify the presence of myocardial ischemia. Patients were excluded from the study if they had known coronary artery disease, had ECG findings diagnostic of myocardial infarction or ischemia, or self-admitted, or tested positive for cocaine use.Results: Of the 220 patients who met inclusion criteria, 6 patients (2.7%; 95% confidence interval 1% to 5.8%) had positive stress test results. Among these 6 patients, 4 underwent subsequent coronary angiography that demonstrated no obstructive coronary disease, suggesting the initial provocative study was falsely positive. For the remaining 2 patients, no diagnostic angiography was performed. Discounting the patients who had negative angiography results, only 2 of 220 study patients (0.9%; 95% confidence interval 0.1% to 3.2%) had a provocative test result that was positive for myocardial ischemia.Conclusion: In our study, a combination of age younger than 40 years, nondiagnostic ECG result, and 2 sets of negative cardiac biomarker results at least 6 hours apart identified a patient group with a very low rate of true-positive provocative testing. Routine stress testing added little to the diagnostic evaluation of this patient group and was falsely positive in all patients who consented to diagnostic coronary angiography (4 of 6 cases). [Ann Emerg Med. 2009;54:12-16.]