Original Research

Limited Use of Outpatient Stress Testing in Young Patients With Atypical Chest Pain

Low prevalence of coronary artery disease within this population suggests that younger patients may not require stress testing for chest pain evaluations as long as pretest likelihood is low.

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The decision to perform stress testing in the evaluation of chest pain is often based on the pretest likelihood of coronary artery disease (CAD). 1-7 Cardiac risk scores, which incorporate smoking status, blood pressure, diabetes mellitus, and cholesterol levels, also may provide further risk stratification. 8-11 Assuming that the prevalence of CAD increases with age, young adults could be deemed low risk, not warranting cardiac screening. 12

Professional society guidelines from the American College of Cardiology/American Heart Association and American College of Physicians 4,5 recommend stress testing as the initial diagnostic test for CAD in symptomatic patients; additionally, the guidelines also suggest that screening stress tests may confer primary prevention benefit in intermediate-risk asymptomatic patients. 9,13 Exercise treadmill testing is considered the initial modality of choice, given its technical ease and lower cost, compared with stress echocardiography. 14

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