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  • Predischarge coronary angiography was better than exercise testing for reducing hospital use after low-risk chest pain

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Therapeutics
Predischarge coronary angiography was better than exercise testing for reducing hospital use after low-risk chest pain

https://doi.org/10.1136/ebm.7.1.14

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    (2001) J Am Coll Cardiol 37, 2042. deFilippi CR, Rosanio S, Tocchi M. , et al. . Randomized comparison of a strategy of predischarge coronary angiography versus exercise testing in low-risk patients in a chest pain unit: in-hospital and long-term outcomes.. Jun 15;. :. –9.
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 QUESTION: In low-risk patients evaluated for chest pain, does a strategy of predischarge coronary angiography (CA) reduce repeated visits and admissions to the emergency department (ED) more than a strategy of predischarge exercise treadmill testing (ETT)?

    Design

    Randomised {allocation concealed*}†, {unblinded}†* controlled trial with a median of 375 days of follow up.

    Setting

    A chest pain unit at the University of Texas Medical Branch at Galveston, Texas, USA.

    Patients

    248 patients 20 to 65 years of age with a ≤ 7% probability of acute myocardial infarction (MI) according to the Goldman algorithm, an absence of electrocardiographic and biochemical markers for ischaemia or infarction, an ability to exercise, and no previous coronary artery disease (CAD). Exclusion criteria were a previous CA or ETT or electrocardiogram confounders for ETT interpretation. 96% of patients completed follow up.

    Intervention

    123 patients were allocated to CA done with a standard femoral …

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    Footnotes

    • Source of funding: in part, Roche Diagnostics.

    • For correspondence: Dr C R deFilippi, University of Maryland, Department of Medicine, Division of Cardiology, Room G3K63, 22 South Greene Street, Baltimore, MD 21201-1595, USA. cdefilip{at}medicine.umaryland.edu.

    • ↵* See glossary.

    • ↵† Information provided by author.