Penumetsa Srikanth C, Mallidi Jaya, Friderici Jennifer L, Hiser William, Rothberg Michael B
Divisions of Cardiology, Baystate Medical Center, Springfield, MA 01199, USA.
Arch Intern Med. 2012 Jun 11;172(11):873-7. doi: 10.1001/archinternmed.2012.940.
Low-risk chest pain is a common cause of hospital admission; however, to our knowledge, there are no guidelines regarding the appropriate use of stress testing in such cases.
We performed a retrospective cohort study of patients 21 years and older who were admitted to our tertiary care center with chest pain in 2007 and 2008. Using electronic records and chart review, we sought (1) to identify differences in the use of stress testing based on patient demographics and comorbidities, pretest probability of coronary artery disease, and house staff coverage and (2) to describe the results of stress testing and patient outcomes, including revascularization procedures and 30-day readmissions for myocardial infarction.
Of 2107 patients, 1474 (69.9%) underwent stress tests, and the results were abnormal in 184 patients (12.5%). Within 30 days, 22 patients (11.6%) with abnormal test results underwent cardiac catheterization, 9 (4.7%) underwent revascularization, and 2 (1.1%) were readmitted for myocardial infarction. In a multivariable model, stress test ordering was positively associated with age younger than 70 years (RR [relative risk], 1.12; 95% CI, 1.02-1.23), private insurance (vs Medicare/Medicaid: RR, 1.19; 95% CI, 1.11-1.27), and no house staff coverage (RR, 1.39; 95% CI, 1.28-1.50). Of patients with low (<10%) pretest probability, 68.0% underwent stress testing, but only 4.5% of these had abnormal test results.
Most patients who are admitted with low-risk chest pain undergo stress testing, regardless of pretest probability, but abnormal test results are uncommon and rarely acted on. Ordering stress tests based on pretest probability could improve efficiency without endangering patients.
低风险胸痛是住院的常见原因；然而，据我们所知，尚无关于在此类情况下适当使用负荷试验的指南。
我们对2007年和2008年因胸痛入住我们三级医疗中心的21岁及以上患者进行了一项回顾性队列研究。通过电子记录和病历审查，我们试图（1）确定基于患者人口统计学和合并症、冠状动脉疾病的预检概率以及住院医生覆盖情况的负荷试验使用差异，以及（2）描述负荷试验结果和患者结局，包括血运重建手术和心肌梗死30天再入院情况。
在2107例患者中，1474例（69.9%）接受了负荷试验，其中184例（12.5%）结果异常。在30天内，22例（11.6%）试验结果异常的患者接受了心导管检查，9例（4.7%）接受了血运重建，2例（1.1%）因心肌梗死再次入院。在多变量模型中，开具负荷试验与年龄小于70岁（相对风险[RR]，1.12；95%可信区间[CI]，1.02 - 1.23）、私人保险（与医疗保险/医疗补助相比：RR，1.19；95%CI，1.11 - 1.27）以及无住院医生覆盖（RR，1.39；95%CI，1.28 - 1.50）呈正相关。在预检概率低（<10%）的患者中，68.0%接受了负荷试验，但其中只有4.5%的试验结果异常。
大多数因低风险胸痛入院的患者接受了负荷试验，无论预检概率如何，但异常试验结果并不常见，且很少据此采取行动。根据预检概率开具负荷试验可提高效率而不危及患者。
