اهميت تست ورزش منفي در پيش آگهي بيماران با درد حاد قفسه سينه

Prognostic significance of negative exercise tolerance test in patients with acute chest pain

Introduction: The purpose of this study was to identify patients suitabale for early discharge after observation for acute chest pain and also demonstrating the prognostic significance of early negative exercise tolerance test in low risk patients with such symptoms. Background: An exercise tolerance test (ETT) is often performed to identify patients suitable for early discharge after observation for acute chest pain (5), but its prognostic significance in low risk patients still remains to be cleared.Therefore we decided to investigate the efficacy of this noninvasive, low cost strategy for our patients to select anginal chest pain due to coronary diseases from other forms, and discharge noncardiae chest pain patients as soon as possible and also to use it as a prognostic guide. Materials and Methods: This descriptive-case study was performed on 190 low risk patients during two years (2001-2003) who underwent ETT within 48 hours after presentation to emergency deptartment with acute chest pain.The patients were followed up to six months for emergency room visits,readmission and Occurance of major cardiac events. Results: The ETT was negative in 152 pts (80%) and positive in rernainig ones (38 pts, 20%).During six months follw up, patients with a negative ETT had fewer additional visit (0.6% vs 21%, P <0.001) and readmission to the hospital (1.3% vs 7.8%, P <0.001) than those with positive ETTs. No pts with a nagative ETT died and only two pts experienced a major cardiac event. Conclusions: Our results suggest that ETT can be safely used to identify pts at low risk of subsequent events. Pts with positive ETT are at increased risk for readmission and cardiac events and should be more closely followed.Being low risk in initial evaluation does not preclude threatening coronary disease.