Abstract 16436: The Limited Utility of Cardiac Stress Testing in Low-Intermediate Risk Young Adults Presenting With Chest Pain.
Introduction: Adults less than 40-years-old have a low prevalence of coronary artery disease. Previous studies examining cardiac stress testing in this population have shown it to be of limited value. We sought to determine the utility of cardiac stress testing in a large multiethnic population of low-intermediate risk young adults that represent a real-world sample in the United States.
Methods: This was a retrospective observational study of 18 to 39 year-old patients being evaluated for chest pain in a Los Angeles hospital from September 2008 to June 2013. Patients were excluded if they had known heart disease, positive cardiac enzymes, ECG findings diagnostic of myocardial infarction or ischemia, or were actively using cocaine. Stress tests were considered positive if the patients reproduced their chest pain and/or developed ischemic ECG changes during the study.
Results: Of the 666 patients who met inclusion criteria, 24 (3.6%; 95% confidence interval [CI] 2.1 to 5.1%) had positive stress tests. Half of these 24 patients went on to have further stress testing and/or coronary angiography that was negative, suggesting that the initial stress test was falsely positive. Discounting these 12 patients, only 12 of 666 (1.8%; 95% CI 0.8 to 2.9%) patients had presumed true positive stress test results, as none of these patients had obstructive coronary artery disease documented by coronary angiography. This yielded a positive predictive value of 50% for this study population.
Conclusions: In this population of low-intermediate risk young adults presenting with chest pain, cardiac stress testing produced as many false positive results as true positive results resulting in a low positive predictive value. Moreover the number of true positive stress tests in this study is presumptive and likely an overestimate, suggesting that the actual prevalence of positive stress tests in this population is even lower. These findings call into question the utility of routine cardiac stress testing in this group, especially in the era of cost-effective medicine.
Author Disclosures: S. Park: None. D.R. Sanchez: None.
- © 2016 by American Heart Association, Inc.