Specifically, computed tomography (CT) scans and cardiac stress tests are overused in the ER for patients with chest pain and provide no information to determine whether a patient is in the midst of a heart attack, the researchers found. Patients who go to the emergency room (ER) with chest pain often receive unnecessary tests to evaluate whether they are having a heart attack, a practice that provides no clinical benefit and adds hundreds of dollars in health-care costs, according to a new study from researchers at Washington University School of Medicine in St. Such patients do not need CT scans or cardiac stress tests, according to the researchers. A new study shows that these patients are getting more testing than is necessary to rule out heart attacks. Ten million people come to the ER with chest pain each year in the United States. Instead, the HEART or TIMI risk scores, which incorporate the first cardiac troponin, provided more diagnostic information.News Release Aggressive testing provides no benefit to patients in ER with chest painĬT scans, cardiac stress tests don’t help in ruling out heart attackīy Julia Evangelou Strait The most useful for identifying patients less likely to have ACS were the low-risk range HEART score (0-3) (LR, 0.20 ), low-risk range TIMI score (0-1) (LR, 0.31 ), or low to intermediate risk designation by the Heart Foundation of Australia and Cardiac Society of Australia and New Zealand risk algorithm (LR, 0.24 ).Ĭonclusions and Relevance Among patients with suspected ACS presenting to emergency departments, the initial history, physical examination, and electrocardiogram alone did not confirm or exclude the diagnosis of ACS. Both the History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) and Thrombolysis in Myocardial Infarction (TIMI) risk scores performed well in diagnosing ACS: LR, 13 (95% CI, 7.0-24) for the high-risk range of the HEART score (7-10) and LR, 6.8 (95% CI, 5.2-8.9) for the high-risk range of the TIMI score (5-7). The most useful electrocardiogram findings were ST-segment depression (specificity, 95% LR, 5.3 ) and any evidence of ischemia (specificity, 91% LR, 3.6 ). Results The clinical findings and risk factors most suggestive of ACS were prior abnormal stress test (specificity, 96% LR, 3.1 ), peripheral arterial disease (specificity, 97% LR, 2.7 ), and pain radiation to both arms (specificity, 96% LR, 2.6 ). ![]() The reference standard for ACS was either a final hospital diagnosis of ACS or occurrence of a cardiovascular event within 6 weeks. Main Outcomes and Measures Sensitivity, specificity, and likelihood ratio (LR) of findings for the diagnosis of ACS. ![]() ![]() ![]() Study Selection MEDLINE and EMBASE were searched (January 1, 1995-July 31, 2015), along with reference lists from retrieved articles, to identify prospective studies of diagnostic test accuracy among patients admitted to the emergency department with symptoms suggesting ACS.ĭata Extraction and Synthesis We identified 2992 unique articles 58 met inclusion criteria. Objective To review systematically the accuracy of the initial history, physical examination, electrocardiogram, and risk scores incorporating these elements with the first cardiac-specific troponin. Early, accurate estimation of the probability of ACS in these patients using the clinical examination could prevent many hospital admissions among low-risk patients and ensure that high-risk patients are promptly treated. Importance About 10% of patients with acute chest pain are ultimately diagnosed with acute coronary syndrome (ACS).
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