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Routine cardiac testing unnecessary in ED patients with chest pain

June 26, 2017

“Cardiovascular testing is costly and time-intensive. Moreover, it is unclear whether current practice reduces the risk of future cardiovascular events in patients without evidence of acute ischemia,” Alexander T. Sandhu, MD, MS, from Veterans Affairs Palo Alto Health Care System, and the Center for Health Policy and Center for Primary Care and Outcomes Research at Stanford University, and colleagues wrote. “Past observational analyses have shown that noninvasive testing is associated with large increases in downstream testing and treatment without a reduction in subsequent acute myocardial infarction (AMI) admissions… However, patients who receive testing are higher risk, raising concerns about residual confounding.”

Researchers examined the relationship between cardiovascular testing using noninvasive imaging or coronary angiography, and changes in the rates of coronary revascularization or acute myocardial infarction (AMI) admission in patients presenting to the ED with chest pain. In this retrospective cohort analysis, they compared weekday presentation with weekend presentation between 2011 and 2012 using national claims data that included 926,633 privately insured patients aged 18 to 64 years. They identified patients who underwent noninvasive testing or coronary angiography within 2 days or 30 days of presentation evaluated coronary revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) and AMI admissions at 7, 30, 180, and 365 days. They also analyzed coronary angiography and coronary artery bypass grafting in patients who received angiography.

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