Usefulness of Clinical Profiling and Exercise Testing in the Prognostic Assessment of Patients Admitted With Chest Pain But Without High-Risk Criteria

Introduction and objectives. Few data are available on the outcome of patients admitted to hospital with suspected acute coronary syndrome who have no high-risk factors and who undergo exercise testing before discharge. Our objectives were to investigate outcomes in this group of patients and to determine whether clinical historytaking or exercise testing can help to predict outcome. Patients and methods. The study population comprised 449 patients admitted to hospital with chest pain suggestive of acute coronary syndrome. All were judged to be at low risk of subsequent events (i.e., none had ischemic ECG changes or an elevation in troponin level). They underwent treadmill exercise testing before discharge, after an observation period of at least 12 hours. Exercise testing was performed after clinical evaluation based on an algorithm involving troponin-T level and resting ECG. The median follow-up duration was 479 days. The single combined endpoint was defined as cardiac death, or hospital admission for nonfatal acute myocardial infarction or unstable angina. Results. Adverse events occurred in 44 (10%) of the 449 patients. A high event rate was associated with four clinical features (i.e., age ≥65 years, diabetes, previous acute myocardial infarction, and typical chest pain) and with a positive result on exercise testing. Conclusions. Adverse events after discharge are not infrequent in patients admitted to hospital with suspected acute coronary syndrome and a low risk profile. Both the patient’s clinical characteristics and exercise test results should be taken into account in accurately determining prognosis.