Risk stratification in patients with chest pain.

Abstract

The evaluation of patients with chest pain and suspected coronary disease remains a challenge for primary care physicians. In this article, three major points are emphasized. First, making full use of the data collected during the initial encounter prior to performance of an exercise test is helpful in formulating assessments of both the likelihood of significant coronary disease and of the short-term risk of a major cardiac event. Second, exercise testing is helpful for intermediate-likelihood patients because positive tests in low-likelihood patients cannot "rule in" disease, and negative tests in high-likelihood patients cannot "rule out" disease. Finally, exercise testing in risk stratification of the patient with suspected coronary artery disease is valuable in identifying low-risk patients in whom further testing, including catheterization, may be safely deferred.