• Adam C Scott, Jennifer Bilesky, Arvin Lamanna, Louise Cullen, Anthony F T Brown, Charles Denaro, and William Parsonage.
• Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.
• Emerg Med Australas. 2014 Apr 1;26(2):170-6.

ObjectiveNational guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated.MethodsA retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary syndrome. Chart review was completed on patients with positive stress tests.ResultsThe 3987 patients with suspected intermediate risk acute coronary syndrome underwent exercise stress testing. One thousand and twenty-seven (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of these 1027 patients had a positive exercise stress test (0.4% incidence of positive exercise stress testing). Of those, three patients had subsequent non-invasive functional testing that yielded a negative result. One patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079-0.115%) (one of 1027 patients).ConclusionsRoutine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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