utilization of stress testing for low-risk patients with chest discomfort in the emergency department

The management of patients presenting to an emergency department with chest discomfort at low-risk for acute coronary syndrome represents a common clinical challenge. such patients are often triaged to chest pain units for monitoring and cardiac stress testing for further risk stratification. we conducted a retrospective study of 292 low-risk patients who presented to an emergency department with chest discomfort. we performed physician-adjudicated chart reviews of all patients with positive stress tests to assess downstream testing, subsequent coronary revascularization, and outcomes. of the 292 patients, 33 (11.3%) had stress tests positive for ischemia, and 12 (4.1%) underwent diagnostic cardiac catheterization. of the 292 patients, 4 (1.4%) underwent coronary revascularization that have resulted in a mortality benefit. these data suggest a very low yield of detecting clinically significant coronary disease with stress testing low-risk patients with chest discomfort in emergency department chest pain units.