Abstract 15588: Applying the Diamond Criteria Could Safely Eliminate Stress Echocardiography for the Majority of Patients Who Present to the Emergency Department With Low-Risk Chest Pain
Background: The optimal management strategy for patients who present to the emergency department (ED) with low-risk chest pain is unknown. Repeated studies have found that the positive predictive value of multiple stress testing modalities in this population is poor and the overall prevalence of finding obstructive coronary artery disease is very low. We hypothesized that applying the Diamond criteria to patients who present to the ED with low risk chest pain would affect the positive predictive value of stress echocardiography and overall cardiovascular outcomes.
Patients and Methods: We performed a retrospective cohort study of 503 patients aged 21 years and older, without a history of obstructive coronary artery disease, who presented to the emergency department with chest pain and were admitted for cardiac observation followed by stress echocardiography between the period January 1, 2012 to December 31, 2012. The positive predictive value of stress echocardiography, determined by cardiac catheterization, and overall cardiovascular outcomes were compared based on patients’ Diamond chest pain classification (typical, atypical, nonanginal, or no chest pain).
Results: In patients with typical chest pain, who accounted for only 8.7% of the total cohort, the positive predictive value of stress echocardiography was 75% compared to 0% for all others subgroups (P = 0.007). Six patients (14%) with typical chest pain went on to have PCI or CABG compared to 0% for all other subgroups (P < 0.001). No patient in any subgroup died or was readmitted with an MI in 30 days.
Conclusion: By using the Diamond criteria for classifying chest pain, stress echocardiography can be safely eliminated for the majority of low-risk patients in the ED. Reforming this practice represents a significant opportunity to reduce “low-value” diagnostic testing.
- © 2013 by American Heart Association, Inc.