Author + information
- Yuanyuan Zhang,
- Brian Levine,
- Mary-Stewart Grote,
- Danielle Minett,
- Avkash Patel,
- Greg Jasani,
- Anitha Rajamanickam and
- Erik Marshall
It is clinically demanding and resource-intensive to exclude ischemia as cause of chest pain in low risk patients. In our hospital, a standard protocol includes a 23 hour observation, serial ECG/troponin, and a subsequent testing which is left to the discretion of the admitting physician. We sought to determine if routine immediate exercise stress echo (IESE), is a useful tool for early triage and safe discharge of low risk patients in the ED.
Low risk chest pain patients (modified TIMI risk score 0 or 1) with a single normal troponin were eligible for IESE. If the baseline echo revealed wall motion abnormalities, stress was not performed (no patient had an abnormal resting echo). These were compared to a cohort of patients with a similar profile admitted to our observation unit (OBS group). Follow-up was made by telephone at 1 month. Clinical cardiac events were defined as MI, death and any cardiac revascularization.
In Oct, 2011 – Sep 2012, 213 patients were enrolled (mean age 46.9 ± 9.0 years, 49% males). There was no significant difference between two groups in terms of clinical history of diabetes, hypertension, dyslipidemia, family history, smoking, and TIMI risk score. 57 patients lost to follow up (21 in IESE group and 36 in OBS group, p=0.089). 155 (73%) patients finished 1 month follow up (78 in IESE group and 77 in OBS group). In the IESE group, 71 patients were discharged directly from ED, 7 had a positive stress echo and 6 received cath (2 had PCI). In the OBS group, 59 received some form of non-invasive testing after overnight stay (49 nuclear SPECT, 8 stress echo, and 2 cardiac CTA), 7 had a cath (2 had PCI), 13 were discharged after serial troponin without imaging with scheduled outpatient follow-up (only 1 presented for outpatient stress). No patient discharged with a negative IESE or from the OBS group had an event. Length of stay of the IESE group was significantly shorter than that of the control group (9.9± 11.4 hrs vs. 23.1 ± 13.0 hrs, p<0.0001).
Utilization of immediate stress echo in the low risk chest pain patients in the ED did not show any increase in cardiac events. A larger, randomized study is needed to confirm the current findings.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: Echo XV
Abstract Category: 18. Imaging: Echo
Presentation Number: 1313-349
- 2013 American College of Cardiology Foundation