Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility

• Main Authors: Yasser Khalil, Melvin H. Schwartz, Prasant S. Pandey, Maida S. Abdul Latif, Martin E. Matsumura
• Format: Article
• Language: English
• Published: Elsevier 2015-06-01
• Series: International Journal of Cardiology: Heart & Vasculature
• Subjects: Myocardial perfusion imaging; Chest pain; Coronary artery disease; Stress testing
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352906714000670

Objective: To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). Methods: Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. Results: 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD− patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. Conclusion: Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.