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The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease

The role of exercise electrocardiography (ECG) in the investigation of stable chest pain has been questioned. The American Heart Association guidelines suggest the use of exercise ECG in patients with stable chest pain and low pre-test probability (PTP) of significant coronary artery disease, while...

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Autores principales: Thorild, Pontus, Mourtzinis, Georgios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380256/
https://www.ncbi.nlm.nih.gov/pubmed/37510785
http://dx.doi.org/10.3390/jcm12144670
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author Thorild, Pontus
Mourtzinis, Georgios
author_facet Thorild, Pontus
Mourtzinis, Georgios
author_sort Thorild, Pontus
collection PubMed
description The role of exercise electrocardiography (ECG) in the investigation of stable chest pain has been questioned. The American Heart Association guidelines suggest the use of exercise ECG in patients with stable chest pain and low pre-test probability (PTP) of significant coronary artery disease, while the European Society of Cardiology Guidelines does not. This retrospective observational study aimed to assess the usefulness of exercise ECG in the low-PTP population with stable chest pain. We reviewed the medical records for all outpatient exercise ECGs conducted because of stable chest pain at the Department of Medicine and Emergency, Sahlgrenska University Hospital, Mölndal, Sweden, during 2016–2018. The identified patients were categorized in low-, intermediate-, or high-risk pre-test probability of significant coronary artery disease. All low-PTP patients were followed for one year post investigation for the incidence of acute coronary syndrome and all-cause mortality. Thus, 505 patients (mean age 60 years, 56% women) with low PTP were included in the study. Only four patients (0.6%) experienced incident myocardial infarction (three patients) or all-cause mortality (one patient). The negative predictive value of exercise ECG was 99.7%, and the positive predictive value was 28.6%. In this low-PTP population, exercise ECG yields a good negative predictive value and a poor positive predictive value.
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spelling pubmed-103802562023-07-29 The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease Thorild, Pontus Mourtzinis, Georgios J Clin Med Brief Report The role of exercise electrocardiography (ECG) in the investigation of stable chest pain has been questioned. The American Heart Association guidelines suggest the use of exercise ECG in patients with stable chest pain and low pre-test probability (PTP) of significant coronary artery disease, while the European Society of Cardiology Guidelines does not. This retrospective observational study aimed to assess the usefulness of exercise ECG in the low-PTP population with stable chest pain. We reviewed the medical records for all outpatient exercise ECGs conducted because of stable chest pain at the Department of Medicine and Emergency, Sahlgrenska University Hospital, Mölndal, Sweden, during 2016–2018. The identified patients were categorized in low-, intermediate-, or high-risk pre-test probability of significant coronary artery disease. All low-PTP patients were followed for one year post investigation for the incidence of acute coronary syndrome and all-cause mortality. Thus, 505 patients (mean age 60 years, 56% women) with low PTP were included in the study. Only four patients (0.6%) experienced incident myocardial infarction (three patients) or all-cause mortality (one patient). The negative predictive value of exercise ECG was 99.7%, and the positive predictive value was 28.6%. In this low-PTP population, exercise ECG yields a good negative predictive value and a poor positive predictive value. MDPI 2023-07-14 /pmc/articles/PMC10380256/ /pubmed/37510785 http://dx.doi.org/10.3390/jcm12144670 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Thorild, Pontus
Mourtzinis, Georgios
The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease
title The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease
title_full The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease
title_fullStr The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease
title_full_unstemmed The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease
title_short The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease
title_sort value of exercise electrocardiography in outpatients with stable chest pain and low pre-test probability of significant coronary artery disease
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380256/
https://www.ncbi.nlm.nih.gov/pubmed/37510785
http://dx.doi.org/10.3390/jcm12144670
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