The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department

Judith M. Poldervaart, A. Jacob Six, Barbra E. Backus, Hector W L De Beaufort, Maarten Jan M Cramer, Rolf F. Veldkamp, E. Gijs Mast, Eugène M. Buijs, Wouter J. Tietge, Björn E. Groenemeijer, Luc Cozijnsen, Alexander J. Wardeh, Hester M. Den Ruiter, Pieter A. Doevendans

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: To improve early diagnostic and therapeutic decision making, we designed the HEART score for chest pain patients in the emergency department (ED). HEART is an acronym of its components: History, ECG, Age, Risk factors and Troponin. Currently, many chest pain patients undergo exercise testing on the consecutive days after presentation. However, it may be questioned how much diagnostic value the exercise ECG adds when the HEART score is already known. Methods: A subanalysis was performed of a multicenter prospective validation study of the HEART score, consisting of 248 patients who underwent exercise testing within 7 days after presentation in the ED. Outcome is the predictive value of exercise testing in terms of major adverse cardiac events (MACE) within 6 weeks after presentation. Results: In low-risk patients (HEART score ≤3), 63.1 % were negative tests, 28.6 % non-conclusive and 8.3 % positive; the latter were all false positives. In the intermediate-risk group (HEART score 4-6), 30.9 % were negative tests, 60.3 % non-conclusive and 8.8 % positive, half of these positives were false positives. In the high-risk patients (HEART score ≥7), 14.3 % were negative tests, 57.1 % non-conclusive and 28.6 % positive, of which half were false positives. Conclusion: In a chest pain population risk stratified with HEART, exercise testing has only a modest contribution to clinical decision making. 50 % of all tests are non-conclusive, with high rates of false positive tests in all three risk groups. In intermediate-risk patients, negative exercise tests may contribute to the exclusion of disease. Clinicians should rather go for sensitive tests, in particular in patients with low HEART scores.

Original languageEnglish
Pages (from-to)305-312
Number of pages8
JournalClinical Research in Cardiology
Volume102
Issue number4
DOIs
Publication statusPublished - Apr 2013

Fingerprint

Chest Pain
Hospital Emergency Service
Electrocardiography
Exercise
Troponin
Validation Studies
Age Factors
Exercise Test
Decision Making
History
Prospective Studies
Population

Keywords

  • Chest pain
  • Emergency department
  • Exercise test
  • HEART
  • Risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Poldervaart, J. M., Six, A. J., Backus, B. E., De Beaufort, H. W. L., Cramer, M. J. M., Veldkamp, R. F., ... Doevendans, P. A. (2013). The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department. Clinical Research in Cardiology, 102(4), 305-312. https://doi.org/10.1007/s00392-012-0535-0

The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department. / Poldervaart, Judith M.; Six, A. Jacob; Backus, Barbra E.; De Beaufort, Hector W L; Cramer, Maarten Jan M; Veldkamp, Rolf F.; Gijs Mast, E.; Buijs, Eugène M.; Tietge, Wouter J.; Groenemeijer, Björn E.; Cozijnsen, Luc; Wardeh, Alexander J.; Den Ruiter, Hester M.; Doevendans, Pieter A.

In: Clinical Research in Cardiology, Vol. 102, No. 4, 04.2013, p. 305-312.

Research output: Contribution to journalArticle

Poldervaart, JM, Six, AJ, Backus, BE, De Beaufort, HWL, Cramer, MJM, Veldkamp, RF, Gijs Mast, E, Buijs, EM, Tietge, WJ, Groenemeijer, BE, Cozijnsen, L, Wardeh, AJ, Den Ruiter, HM & Doevendans, PA 2013, 'The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department', Clinical Research in Cardiology, vol. 102, no. 4, pp. 305-312. https://doi.org/10.1007/s00392-012-0535-0
Poldervaart, Judith M. ; Six, A. Jacob ; Backus, Barbra E. ; De Beaufort, Hector W L ; Cramer, Maarten Jan M ; Veldkamp, Rolf F. ; Gijs Mast, E. ; Buijs, Eugène M. ; Tietge, Wouter J. ; Groenemeijer, Björn E. ; Cozijnsen, Luc ; Wardeh, Alexander J. ; Den Ruiter, Hester M. ; Doevendans, Pieter A. / The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department. In: Clinical Research in Cardiology. 2013 ; Vol. 102, No. 4. pp. 305-312.
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abstract = "Background: To improve early diagnostic and therapeutic decision making, we designed the HEART score for chest pain patients in the emergency department (ED). HEART is an acronym of its components: History, ECG, Age, Risk factors and Troponin. Currently, many chest pain patients undergo exercise testing on the consecutive days after presentation. However, it may be questioned how much diagnostic value the exercise ECG adds when the HEART score is already known. Methods: A subanalysis was performed of a multicenter prospective validation study of the HEART score, consisting of 248 patients who underwent exercise testing within 7 days after presentation in the ED. Outcome is the predictive value of exercise testing in terms of major adverse cardiac events (MACE) within 6 weeks after presentation. Results: In low-risk patients (HEART score ≤3), 63.1 {\%} were negative tests, 28.6 {\%} non-conclusive and 8.3 {\%} positive; the latter were all false positives. In the intermediate-risk group (HEART score 4-6), 30.9 {\%} were negative tests, 60.3 {\%} non-conclusive and 8.8 {\%} positive, half of these positives were false positives. In the high-risk patients (HEART score ≥7), 14.3 {\%} were negative tests, 57.1 {\%} non-conclusive and 28.6 {\%} positive, of which half were false positives. Conclusion: In a chest pain population risk stratified with HEART, exercise testing has only a modest contribution to clinical decision making. 50 {\%} of all tests are non-conclusive, with high rates of false positive tests in all three risk groups. In intermediate-risk patients, negative exercise tests may contribute to the exclusion of disease. Clinicians should rather go for sensitive tests, in particular in patients with low HEART scores.",
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AU - Poldervaart, Judith M.

AU - Six, A. Jacob

AU - Backus, Barbra E.

AU - De Beaufort, Hector W L

AU - Cramer, Maarten Jan M

AU - Veldkamp, Rolf F.

AU - Gijs Mast, E.

AU - Buijs, Eugène M.

AU - Tietge, Wouter J.

AU - Groenemeijer, Björn E.

AU - Cozijnsen, Luc

AU - Wardeh, Alexander J.

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AU - Doevendans, Pieter A.

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N2 - Background: To improve early diagnostic and therapeutic decision making, we designed the HEART score for chest pain patients in the emergency department (ED). HEART is an acronym of its components: History, ECG, Age, Risk factors and Troponin. Currently, many chest pain patients undergo exercise testing on the consecutive days after presentation. However, it may be questioned how much diagnostic value the exercise ECG adds when the HEART score is already known. Methods: A subanalysis was performed of a multicenter prospective validation study of the HEART score, consisting of 248 patients who underwent exercise testing within 7 days after presentation in the ED. Outcome is the predictive value of exercise testing in terms of major adverse cardiac events (MACE) within 6 weeks after presentation. Results: In low-risk patients (HEART score ≤3), 63.1 % were negative tests, 28.6 % non-conclusive and 8.3 % positive; the latter were all false positives. In the intermediate-risk group (HEART score 4-6), 30.9 % were negative tests, 60.3 % non-conclusive and 8.8 % positive, half of these positives were false positives. In the high-risk patients (HEART score ≥7), 14.3 % were negative tests, 57.1 % non-conclusive and 28.6 % positive, of which half were false positives. Conclusion: In a chest pain population risk stratified with HEART, exercise testing has only a modest contribution to clinical decision making. 50 % of all tests are non-conclusive, with high rates of false positive tests in all three risk groups. In intermediate-risk patients, negative exercise tests may contribute to the exclusion of disease. Clinicians should rather go for sensitive tests, in particular in patients with low HEART scores.

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