Key result
Typical chest pain by Diamond criteria yielded a 75% positive predictive value for stress echocardiography compared to 0% for other subgroups (P=0.007).
Why the study?
Does applying the Diamond chest pain classification improve the utilization and predictive value of stress echocardiography in emergency department patients with low-risk chest pain?
Cohort (n=503)
Does applying the Diamond chest pain classification improve the utilization and predictive value of stress echocardiography in emergency department patients with low-risk chest pain?
Absolute Event Rate: 75% vs 0%
p-value: p=0.007
Applying the Diamond criteria to emergency department patients with low-risk chest pain effectively identifies the small subset of patients who yield true positive stress echocardiograms and require revascularization, suggesting routine testing in other subgroups may be unnecessary.
May support selective stress echocardiography in Diamond-typical low-risk ED chest pain; leaves open whether testing can be safely omitted in other subgroups.
We identified all patients with age 21 years and older, without a history of obstructive coronary artery disease, who presented to the emergency department with chest pain, and were admitted for cardiac observation followed by stress echocardiography during a 1-year period. The positive predictive value of stress echocardiography and cardiovascular outcomes were compared based on patients' Diamond chest pain classification. In patients with typical chest pain, who accounted for 8.7% (44/503) of the total cohort, the positive predictive value of stress echocardiography was 75% compared with 0% for all other subgroups (P = 0.007). Six patients (14%) with typical chest pain went on to have coronary revascularization compared with 0% for all other subgroups (P < 0.001). No patient in any subgroup died or was readmitted with a myocardial infarction in 30 days. Applying the Diamond criteria could improve utilization of stress echocardiography for patients with low-risk chest pain in the emergency department.
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Foy et al. (2014) conducted a cohort in Low-risk chest pain (n=503). Typical chest pain (Diamond criteria) vs. All other subgroups was evaluated on Positive predictive value of stress echocardiography (p=0.007). Typical chest pain by Diamond criteria yielded a 75% positive predictive value for stress echocardiography compared to 0% for other subgroups (P=0.007).
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