Association of early stress testing with outcomes for emergency department evaluation of suspected acute coronary syndrome

Benjamin Sun, Amber Laurie, Rongwei (Rochelle) Fu, Maros Ferencik, Michael Shapiro, Christopher J. Lindsell, Deborah Diercks, James W. Hoekstra, Judd E. Hollander, J. Douglas Kirk, W. Frank Peacock, W. Brian Gibler, Venkataraman Anantharaman, Charles V. Pollack

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (eD) evaluation for suspected acute coronary syndrome (acS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. Methods: We analyzed prospectively collected data from 9 eDs on patients with suspected acS, 1999-2001. We excluded patients with an eD diagnosis of acS. the primary outcome was 30-day major adverse cardiac events (Maces), including all-cause death, acute myocardial infarction, and revascularization. We used the Heart score to determine pretest acS risk (low, intermediate, and high). to mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores. Results: Of 7127 potentially eligible patients, 895 (13%) received early stress testing. the analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. the overall 30-day Mace rate in both the source and analytic population was 3%. there were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). there was no association between early stress testing and 30-day Mace [odds ratio, 1.0; 95% confidence interval (ci), 0.6-1.7]. there was no effect modification by pretest risk (low: odds ratio, 1.0; 95% ci, 0.2-3.7; intermediate: 1.2; 95% ci, 0.6-2.6; high: 0.4; 95% ci, 0.1-1.6). Conclusions: early stress testing is not associated with reduced Mace in patients evaluated for suspected acS. early stress testing may have limited value in populations with low Mace rate.

Original languageEnglish (US)
Pages (from-to)60-68
Number of pages9
JournalCritical Pathways in Cardiology
Volume15
Issue number2
DOIs
StatePublished - Jun 1 2016

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omega-Chloroacetophenone
Acute Coronary Syndrome
Hospital Emergency Service
Confidence Intervals
Propensity Score
Odds Ratio
Myocardial Revascularization
Population
Cause of Death
Myocardial Infarction
Guidelines

Keywords

  • Chest Pain
  • Emergency department
  • Stress test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of early stress testing with outcomes for emergency department evaluation of suspected acute coronary syndrome. / Sun, Benjamin; Laurie, Amber; Fu, Rongwei (Rochelle); Ferencik, Maros; Shapiro, Michael; Lindsell, Christopher J.; Diercks, Deborah; Hoekstra, James W.; Hollander, Judd E.; Douglas Kirk, J.; Frank Peacock, W.; Brian Gibler, W.; Anantharaman, Venkataraman; Pollack, Charles V.

In: Critical Pathways in Cardiology, Vol. 15, No. 2, 01.06.2016, p. 60-68.

Research output: Contribution to journalArticle

Sun, B, Laurie, A, Fu, RR, Ferencik, M, Shapiro, M, Lindsell, CJ, Diercks, D, Hoekstra, JW, Hollander, JE, Douglas Kirk, J, Frank Peacock, W, Brian Gibler, W, Anantharaman, V & Pollack, CV 2016, 'Association of early stress testing with outcomes for emergency department evaluation of suspected acute coronary syndrome', Critical Pathways in Cardiology, vol. 15, no. 2, pp. 60-68. https://doi.org/10.1097/HPc.0000000000000068
Sun, Benjamin ; Laurie, Amber ; Fu, Rongwei (Rochelle) ; Ferencik, Maros ; Shapiro, Michael ; Lindsell, Christopher J. ; Diercks, Deborah ; Hoekstra, James W. ; Hollander, Judd E. ; Douglas Kirk, J. ; Frank Peacock, W. ; Brian Gibler, W. ; Anantharaman, Venkataraman ; Pollack, Charles V. / Association of early stress testing with outcomes for emergency department evaluation of suspected acute coronary syndrome. In: Critical Pathways in Cardiology. 2016 ; Vol. 15, No. 2. pp. 60-68.
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abstract = "Background: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (eD) evaluation for suspected acute coronary syndrome (acS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. Methods: We analyzed prospectively collected data from 9 eDs on patients with suspected acS, 1999-2001. We excluded patients with an eD diagnosis of acS. the primary outcome was 30-day major adverse cardiac events (Maces), including all-cause death, acute myocardial infarction, and revascularization. We used the Heart score to determine pretest acS risk (low, intermediate, and high). to mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores. Results: Of 7127 potentially eligible patients, 895 (13{\%}) received early stress testing. the analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. the overall 30-day Mace rate in both the source and analytic population was 3{\%}. there were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). there was no association between early stress testing and 30-day Mace [odds ratio, 1.0; 95{\%} confidence interval (ci), 0.6-1.7]. there was no effect modification by pretest risk (low: odds ratio, 1.0; 95{\%} ci, 0.2-3.7; intermediate: 1.2; 95{\%} ci, 0.6-2.6; high: 0.4; 95{\%} ci, 0.1-1.6). Conclusions: early stress testing is not associated with reduced Mace in patients evaluated for suspected acS. early stress testing may have limited value in populations with low Mace rate.",
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AU - Laurie, Amber

AU - Fu, Rongwei (Rochelle)

AU - Ferencik, Maros

AU - Shapiro, Michael

AU - Lindsell, Christopher J.

AU - Diercks, Deborah

AU - Hoekstra, James W.

AU - Hollander, Judd E.

AU - Douglas Kirk, J.

AU - Frank Peacock, W.

AU - Brian Gibler, W.

AU - Anantharaman, Venkataraman

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N2 - Background: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (eD) evaluation for suspected acute coronary syndrome (acS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. Methods: We analyzed prospectively collected data from 9 eDs on patients with suspected acS, 1999-2001. We excluded patients with an eD diagnosis of acS. the primary outcome was 30-day major adverse cardiac events (Maces), including all-cause death, acute myocardial infarction, and revascularization. We used the Heart score to determine pretest acS risk (low, intermediate, and high). to mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores. Results: Of 7127 potentially eligible patients, 895 (13%) received early stress testing. the analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. the overall 30-day Mace rate in both the source and analytic population was 3%. there were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). there was no association between early stress testing and 30-day Mace [odds ratio, 1.0; 95% confidence interval (ci), 0.6-1.7]. there was no effect modification by pretest risk (low: odds ratio, 1.0; 95% ci, 0.2-3.7; intermediate: 1.2; 95% ci, 0.6-2.6; high: 0.4; 95% ci, 0.1-1.6). Conclusions: early stress testing is not associated with reduced Mace in patients evaluated for suspected acS. early stress testing may have limited value in populations with low Mace rate.

AB - Background: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (eD) evaluation for suspected acute coronary syndrome (acS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. Methods: We analyzed prospectively collected data from 9 eDs on patients with suspected acS, 1999-2001. We excluded patients with an eD diagnosis of acS. the primary outcome was 30-day major adverse cardiac events (Maces), including all-cause death, acute myocardial infarction, and revascularization. We used the Heart score to determine pretest acS risk (low, intermediate, and high). to mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores. Results: Of 7127 potentially eligible patients, 895 (13%) received early stress testing. the analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. the overall 30-day Mace rate in both the source and analytic population was 3%. there were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). there was no association between early stress testing and 30-day Mace [odds ratio, 1.0; 95% confidence interval (ci), 0.6-1.7]. there was no effect modification by pretest risk (low: odds ratio, 1.0; 95% ci, 0.2-3.7; intermediate: 1.2; 95% ci, 0.6-2.6; high: 0.4; 95% ci, 0.1-1.6). Conclusions: early stress testing is not associated with reduced Mace in patients evaluated for suspected acS. early stress testing may have limited value in populations with low Mace rate.

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KW - Emergency department

KW - Stress test

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