Document Detail

Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study.
MedLine Citation:
PMID:  17227784     Owner:  NLM     Status:  MEDLINE    
AIMS: Patients attending hospital with suspected acute coronary syndrome (ACS), non-diagnostic electrocardiogram (ECG), and negative troponin present a diagnostic dilemma for admitting physicians. We sought to determine the clinical and economic impact of stress echocardiography (SEcho) when compared with exercise ECG (ExECG) in the assessment of these patients. METHODS AND RESULTS: Following pre-test assessment by (Thrombolysis in Myocardial Infarction) TIMI score, patients were randomized to ExECG (n=218) or SEcho (n=215). Subsequently, low-risk patients were discharged; those considered high risk were referred for coronary angiography. Patients were followed-up for cardiac events and a cost-analysis performed. SEcho was superior to ExECG in stratifying patients as low risk (77 vs. 33%, respectively, P<0.0001) with no difference in cardiac event rate (5 vs. 3%, respectively). SEcho classified fewer patients as intermediate risk (3 vs. 39%, respectively, P<0.0001) and fewer patients required further tests when compared with ExECG (3 vs. 47%, respectively, P<0.0001). Costs for detection of coronary artery disease were significantly less in patients undergoing SEcho (pound366.63 vs. pound515.48, P=0.004). CONCLUSION: SEcho is superior to ExECG in the risk stratification of patients with suspected ACS but negative troponin. SEcho resulted in less diagnostic uncertainty, fewer referrals for further investigation, and hence, a significant cost benefit over ExECG.
Paramjit Jeetley; Leah Burden; Boyka Stoykova; Roxy Senior
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-01-16
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-31     Completed Date:  2007-11-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  204-11     Citation Subset:  IM    
Department of Cardiovascular Medicine, Northwick Park Hospital and Institute for Medical Research, and Health Economics Research Group, Brunel University, Middlesex, UK.
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MeSH Terms
Analysis of Variance
Coronary Angiography
Coronary Artery Disease / economics,  radiography,  ultrasonography*
Costs and Cost Analysis
Echocardiography, Stress / economics
Exercise Test
Follow-Up Studies
Middle Aged
Myocardial Ischemia / economics,  radiography,  ultrasonography*
Prospective Studies
Risk Factors
Troponin / metabolism*
Reg. No./Substance:
Comment In:
Eur Heart J. 2007 Jan;28(2):148-9   [PMID:  17227785 ]
Eur Heart J. 2007 Aug;28(15):1912; author reply 1912   [PMID:  17606469 ]
Evid Based Med. 2007 Aug;12(4):119   [PMID:  17885167 ]
ACP J Club. 2007 Jul-Aug;147(1):10   [PMID:  17608375 ]

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