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Background: Stress echocardiography (SE) is commonly used in ED patients with symptoms concerning for acute coronary syndrome (ACS). Prior studies have found the false positive (FP) rate of SE, as well as other stress testing modalities, in this setting, is greater than 50%. We sought to determine the risk of major cardiac events in patients with FP versus negative SE's.
Methods: The study population consisted of consecutive patients from 2010 to 2012, without a history of heart disease, who were admitted to the ED observation unit of a single academic center and underwent SE per protocol. A FP study was defined as a positive SE, using standard ASE criteria, followed by a cardiac catheterization without obstructive CAD. FP patients were matched 1:2 based on age, sex, and METS achieved with negative SE control subjects. Primary study endpoints included admission for MI, CHF, or death from any cause. The percentage of patients who experienced an event was compared between groups using Fisher's test.
Results: A total of 1,299 patients underwent SE; the average age was 54 and 55% were female. Eighty-three (6.3%) patients had a positive SE and underwent cardiac catheterization; 43 (51.8%) were found to be FP. The average age of patients in the FP (n=43) and matched control group (n=86) was 56 and 51% were female. Patients in the FP group were significantly more likely to experience a primary event compared to matched controls (20.9% vs. 6.2%, p=0.012). The average time to an event was 4 years in both groups.
Conclusions: ED observation unit patients with a FP SE are at increased risk of major cardiac events compared to those with negative SE results. This patient cohort may benefit from closer follow-up and should be given consideration for interventions aimed at secondary prevention. Additional studies are required to examine the underlying mechanisms responsible for these findings and to assess whether other FP stress test modalities carry similar risks. This finding may represent an advantage for SE, highlighting the importance of stress-induced wall motion compared to other markers of ischemia.
Moderated Poster Contributions
Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:00 p.m.-1:10 p.m.
Session Title: Which Test Is Best for Pain in the Chest?
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1317M-07
- 2017 American College of Cardiology Foundation