Evidence That Provocative Testing in Low-Risk Chest Pain Patients Does Not Prevent MI

In a simulated randomized trial, emergency department patients with chest pain who underwent provocative testing had more interventions but not fewer myocardial infarctions than those who did not undergo testing.

There is no evidence to support the recommended practice of provocative testing or computed tomographic coronary angiography (CTCA) in low-risk chest pain patients. Recent observational studies have suggested that such testing may increase the likelihood of invasive medical treatment without conferring benefit. Now investigators report findings of a study that simulated a randomized trial by comparing outcomes between patients who presented to the emergency department (ED) with chest pain on weekdays versus weekends.

Using a commercial claims database, the investigators retrospectively analyzed nearly 1 million ED visits for chest pain among patients aged 18 to 64 years. After controlling for potential confounders, patients who presented on …

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Evidence That Provocative Testing in Low-Risk Chest Pain Patients Does Not Prevent MI

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Reviewing Author