Evaluation of chest pain in low-risk patients presenting to the emergency department: the role of immediate exercise testing

Ann Emerg Med. 1998 Jul;32(1):1-7. doi: 10.1016/s0196-0644(98)70091-5.


Study objectives: To determine the safety and utility of immediate exercise testing in the evaluation of low-risk patients presenting to the emergency department with chest pain and its applicability to a heterogeneous population of men and women.

Methods: We conducted a prospective study of the safety and utility of immediate exercise testing in low-risk patients, as indicated by clinical and ECG criteria. The study group was large, heterogeneous, and included patients with a history of coronary artery disease. The patients were treated at a large, university medical center. Exercise testing (immediate exercise treadmill testing) was performed by internists, and cardiac serum enzyme levels were not measured before the exercise test.

Results: A total of 212 patients (121 men, 91 women) underwent exercise testing with no adverse effects. Twenty-eight (13%) patients had positive results on exercise ECGs. Twenty-three of the latter had further evaluation that revealed evidence of coronary artery disease in 13 (57%). Fifty-nine percent (125/212) of patients had negative exercise test results and 28% (59/212) had nondiagnostic tests. All patients with negative test results and 93% with nondiagnostic test results were discharged directly from the ED. Thirty-day follow-up was achieved in 201 (95%) patients and revealed no mortality in any of the patients in the three groups. One patient with a positive exercise test result returned to the ED within 30 days with mild congestive heart failure.

Conclusion: Our results in this patient population support the safety and utility of immediate exercise testing of low-risk patients who present to the ED.

MeSH terms

  • Adult
  • Angina Pectoris / etiology*
  • California
  • Chest Pain / etiology*
  • Diagnosis, Differential
  • Emergency Service, Hospital
  • Emergency Treatment / methods*
  • Exercise Test / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis*
  • Prospective Studies
  • Safety*