Non-invasive coronary angiography for patients with acute atypical chest pain discharged after negative screening including maximal negative treadmill stress test. A prospective study

Background- There are few studies which compared invasive coronary angiography (CAG) in patients presenting with chest pain (atypical, probably ischemic) in outpatient department with negative or inconclusive treadmill stress test (TMT). Objective- To assess CAG findings in patient with suspected iscemic chest pain, with negative or inconclusive TMT. Methods- Patients with chest pain (atypical, probably ischemic) underwent TMT and classified as TMT negative or inconclusive. These patients underwent CAG and findings were analysed. Results - 50 patients completed the study protocol. Of these 50 patients who underwent TMT, 31 (62%) were TMT negative and 19 (38%) were TMT inconclusive. In TMT negative group CAG showed obstructive lesion in 6(19.4%), and non obstructive lesion in 25(80.6%). In TMT inconclusive group CAG showed obstructive lesion in 11(57.8%), while non obstructive lesion in 8(42.2%). Conclusion-In patients with atypical chest pain with negative or inconclusive TMT with suspicion of coronary ischemia CAG provides an important diagnostic tool for assessing, especially with TMT inconclusive group.

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Multivariate Approach to the Treadmill Stress Test: Prospective Study

Cardiology ◽

10.1159/000173314 ◽

1981 ◽

Vol 68 (2) ◽

pp. 27-34 ◽

Cited By ~ 3

Author(s):

Myrvin H. Ellestad ◽

Paul S. Greenberg

Keyword(s):

Prospective Study ◽

Stress Test ◽

Multivariate Approach ◽

Treadmill Stress Test ◽

Treadmill Stress

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The Ordering of Medical Things: Medical Practices and Complexity

10.26686/wgtn.16968466.v1 ◽

2021 ◽

Author(s):

◽

John Gardner

Keyword(s):

Chest Pain ◽

Stress Test ◽

Actor Network Theory ◽

The Body ◽

Single Individual ◽

Medical Practices ◽

Making Sense ◽

Video And Audio ◽

Treadmill Stress Test ◽

Treadmill Stress

<p>This project is an investigation into medicine in action. The aim is to understand how medical interactions generate order via the diagnosis of disease; how the patient, the body, and illness are made intelligible, and how particular courses of action are decided upon as a result. Using video and audio data supplied by the Applied Research on Communication in Health (ARCH) research team, this project follows Simon, a middle aged, Caucasian male with chest pain, as he participates in consultations with his GP and cardiologist, and as he undergoes a cardio treadmill-stress test. This project argues for adopting an Actor-Network theory (ANT) based approach to studying interactions. Unlike more traditional sociology approaches, this project considers the role of non-human objects in interaction. Non-human objects are often key actors in the interactions that provide the world with a sense of order. I will provide an epistemological justification for ANT's key premises and outline the method that these premises entail. Following three interactions, this project illustrates that the principal actors involved in producing intelligibility varies. In the GP consultation, the GP and Simon were principal actors in rendering chest pain intelligible. In the treadmill stress test, the material instrumentation, carefully aligned with the Simon's body by the cardiologist, was vital to ensuring a particular account of the heart was produced. Simon was little more than a compliant body in this interaction. In the final interaction, the cardiologist was the principal actor in making sense of these accounts of chest pain and the potentially conflicting picture of the "healthy" heart. The cardiologist suggests that the account of the heart produced by the treadmill-stress test may be flawed, and encourages Simon to self-monitor and self-regulate. I will argue that the uncertainty generated by conflicting accounts is common to medical practices. Medical professionals respond to this by encouraging individuals to monitor and reduce risk. By adopting the ANT approach, I found that the patient and his body are sometimes intelligible as somatic entities, sometimes as an expressive, accounting agent, and sometimes as a self-responsible individual. These various renditions hold together as a being a single individual "Simon".</p>

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Correlation of Treadmill stress test with coronary angiography in patients with coronary artery disease using Selzer's criteria

Indian Heart Journal ◽

10.1016/j.ihj.2015.10.059 ◽

2015 ◽

Vol 67 ◽

pp. S24

Author(s):

Chetan Sharma ◽

C.P. Tripathi ◽

Madhavi Tripathi ◽

R.K. Pandey ◽

Naveed Bisht ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Stress Test ◽

Artery Disease ◽

Treadmill Stress Test ◽

Treadmill Stress

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Abstract 323: Assessment of Coronary Artery Calcium on Routine Non-gated Chest Computed Tomography to Risk Stratify Patients Presenting With Chest Pain

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.323 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Richard Vautier ◽

Dae Hyun Lee ◽

Yasmin Ayoubi ◽

Paula Hernandez Burgos ◽

Fahad Hawk ◽

...

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Coronary Angiography ◽

Predictive Value ◽

Coronary Artery Stenosis ◽

Stress Test ◽

Invasive Coronary Angiography ◽

Chest Ct ◽

Cardiac Stress ◽

Risk Patients

Background: Coronary artery calcium (CAC) scoring is an important tool for cardiovascular risk stratification. CAC scoring in both asymptomatic and symptomatic, low-intermediate risk patients has also shown prognostic utility and has a high negative predictive value for obstructive coronary artery disease (CAD). Patients who present with chest pain frequently undergo non-gated chest computed tomography (CT) to evaluate for non-cardiac etiologies. In fact, several studies have demonstrated that a CAC score from a non-gated chest CT correlates well with a dedicated calcium-scoring CT. However, the predictive value on CAD through assessing the presence (CAC>0) or the absence of calcium (CAC=0) detected on non-gated chest CT in patients presenting with chest pain is unknown. Methods: Low-intermediate risk patients (n=92) presenting to the emergency department with chest pain who underwent non-gated chest CT and were subsequently evaluated with either a cardiac stress test or invasive coronary angiography were included. Dichotomous CAC was assessed in a blinded fashion and classified as CAC=0 or CAC>0. Obstructive CAD was defined as either: ischemia on stress testing or any coronary artery stenosis greater than 70% (left main coronary artery stenosis greater than 50%) on invasive coronary angiography. Results: CAC=0 on non-gated chest CT was found in 59.2% (n=42). Patients with CAC=0 had a significantly lower age and TIMI score compared to patients with a CAC>0. (p<0.01 ) Patients with a CAC>0 were found to more likely have obstructive CAD on subsequent testing: cardiac stress test (Likelihood ratio[LR]:6.42, p=0.022); and invasive angiography (LR:12.46, p=0.002). There were no patients with a CAC=0 that were found to have obstructive CAD on invasive coronary angiography, resulting in a 100% sensitivity and 100% negative predictive value. Conclusion: Patient who presents with chest pain frequently undergo evaluation with a non-gated chest CT to assess non-cardiac etiologies. Exclusion of CAC on non-gated chest CT may be useful as an adjunct for further risk stratification to avoid potential adverse events and cost associated with further testing.

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Abstract 1796: A Clinical Prediction Rule for Early Emergency Department Discharge of Lower Risk Patients with Chest Pain

Circulation ◽

10.1161/circ.116.suppl_16.ii_382-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Vlad Cotarlan ◽

David Ho ◽

John Pineda ◽

Pavlo I Netrebko ◽

Timothy McConnell ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Stress Test ◽

Prediction Rule ◽

Acute Chest Pain ◽

Clinical Prediction Rule ◽

Cardiac Enzymes ◽

Atypical Chest Pain ◽

Non Invasive ◽

Invasive Test

Background. Emergency Department (ED) evaluation of patients with acute chest pain and non-diagnostic electrocardiography (ECG) remains a frequent and difficult problem. Stress testing is generally requested and may lead to costly, unnecessary and prolonged ED stay. We aimed to identify clinical characteristics that allow early discharge with outpatient evaluation of such patients. Methods. Between 02/2006 and 02/2007, 459 adults [age 56±13 years, 228 (50%) men] who presented to ED with chest pain and had no ischemic ECG changes and 2 negative cardiac enzymes measurements on arrival and 6 hours later, underwent stress echocardiography (n=396) or coronary computed tomographic angiography (n=63) prior to discharge. Results. Non-invasive evaluation for coronary artery disease (CAD) was negative in 367 (80%), indeterminate in 30 (7%) and positive in 62 (13%) [Table ]. Univariate predictors for a normal stress test were lower Framingham risk score, lower age, normal ECG (no ischemic changes), atypical chest pain and the absence of diabetes, hypertension, high cholesterol and previous CAD. Multivariate logistic regression identified normal ECG (RR=2.3, p=0.002), atypical chest pain (RR=3.0, p=0.001), no diabetes (RR=2.5, p=0.001) or absence of previous CAD (RR=2.8, p<0.001) as strong independent predictors for a negative non-invasive test. The same four variables were strong independent predictors of ED discharge. Of 459 patients, 186 (41%) had none of the four independent predictors. None of those had positive non-invasive test or obstructive CAD on angiogram (n=1). Conclusion. A substantial portion (2/5) of patients seen in ED for chest pain evaluation can be safely discharged after 2 sets of negative cardiac enzymes (~6 hours) if they have a normal ECG, atypical chest pain, no diabetes or previous CAD. These patients can be evaluated for CAD as an outpatient. This strategy may significantly decrease length of stay, ED clutter and cost of in-patient evaluation.

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The Ordering of Medical Things: Medical Practices and Complexity

10.26686/wgtn.16968466 ◽

2021 ◽

Author(s):

◽

John Gardner

Keyword(s):

Chest Pain ◽

Stress Test ◽

Actor Network Theory ◽

The Body ◽

Single Individual ◽

Medical Practices ◽

Making Sense ◽

Video And Audio ◽

Treadmill Stress Test ◽

Treadmill Stress

<p>This project is an investigation into medicine in action. The aim is to understand how medical interactions generate order via the diagnosis of disease; how the patient, the body, and illness are made intelligible, and how particular courses of action are decided upon as a result. Using video and audio data supplied by the Applied Research on Communication in Health (ARCH) research team, this project follows Simon, a middle aged, Caucasian male with chest pain, as he participates in consultations with his GP and cardiologist, and as he undergoes a cardio treadmill-stress test. This project argues for adopting an Actor-Network theory (ANT) based approach to studying interactions. Unlike more traditional sociology approaches, this project considers the role of non-human objects in interaction. Non-human objects are often key actors in the interactions that provide the world with a sense of order. I will provide an epistemological justification for ANT's key premises and outline the method that these premises entail. Following three interactions, this project illustrates that the principal actors involved in producing intelligibility varies. In the GP consultation, the GP and Simon were principal actors in rendering chest pain intelligible. In the treadmill stress test, the material instrumentation, carefully aligned with the Simon's body by the cardiologist, was vital to ensuring a particular account of the heart was produced. Simon was little more than a compliant body in this interaction. In the final interaction, the cardiologist was the principal actor in making sense of these accounts of chest pain and the potentially conflicting picture of the "healthy" heart. The cardiologist suggests that the account of the heart produced by the treadmill-stress test may be flawed, and encourages Simon to self-monitor and self-regulate. I will argue that the uncertainty generated by conflicting accounts is common to medical practices. Medical professionals respond to this by encouraging individuals to monitor and reduce risk. By adopting the ANT approach, I found that the patient and his body are sometimes intelligible as somatic entities, sometimes as an expressive, accounting agent, and sometimes as a self-responsible individual. These various renditions hold together as a being a single individual "Simon".</p>

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Correlation of Treadmill Stress Test with Coronary Angiography to Predict Coronary Artery Disease in Males versus Females

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0037-1607032 ◽

2017 ◽

Vol 02 (03) ◽

pp. 025-028

Author(s):

B. Maneesh Kumar ◽

Edavaluru Bhuvaneshwari

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

High Probability ◽

Stress Test ◽

Inducible Ischemia ◽

Male Sex ◽

Artery Disease ◽

Treadmill Stress Test ◽

Treadmill Stress

Background Treadmill stress test (TMT) is the most commonly performed stress test for diagnosis of coronary artery disease (CAD) in outpatient setting. The present study was conducted to find correlation of TMT with coronary angiography (CAG) in males versus female patients. Methods Total 422 patients who had undergone CAG and TMT were enrolled in present study. TMT test was done using Bruce protocol, and results were classified as inconclusive, low, intermediate, and high probability for inducible ischemia. Results Of 422 patients enrolled in the present study, 290 (69%) were males and 132 (31%) were females. Clinical presentation was angina on exertion CCS class II–III in 302 (71.6%) patients and angina equivalent in 124 (29.4%) patients. Out of these, 211 (50.2%) were diabetic and 308 (72.9%) were hypertensive. TMT was inconclusive, low, intermediate, and high probability for inducible ischemia in 35 (8.2%), 40 (9.7%), 19 (4.5%), and 328 (77.7%) patients, respectively. CAGs were normal in 149 (35.4%) patients and abnormal in 273 (64.6%) patients. Out of 328 patients with strongly positive TMT, 104 (31.7%) had normal coronaries, 56 (17%) had mild CAD, while 75 (22.8%) had SVD. LMCA disease, DVD, and TVD were found in 5 (1.5%), 48 (14.6%), and 40 (12.1%) patients, respectively. Of 132 female patients, 70 (53%) were found to have CAD and 62 (47%) had normal coronaries on CAG. Of 290 males, 241(83.1%) were found to have CAD and 49 (16.8%) had normal coronaries on CAG. Positive predictive value (PPV) in females was 53% and in males was 83%. Subgroup analysis showed that if there was high-probability TMT along with older age (p < 0.00), male sex (p < 0.01), and diabetes (p < 0.00), chances of having CAD were more. Conclusion PPV of positive TMT in female is 53% and in male is 83%. High-probability TMT along with the older age, male sex, and presence of diabetes mellitus (DM) makes the probability of having CAD is high.

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