Comparison of Early Dobutamine Stress Echocardiography and Exercise Electrocardiographic Testing for Management of Patients Presenting to the Emergency Department With Chest Pain

Gaetano Nucifora, Luigi P. Badano, Nizal Sarraf-Zadegan, Apostolos Karavidas, Giuseppe Trocino, Giorgio Scaffidi, Gianni Pettinati, Costantino Astarita, Vitas Vysniauskas, Dario Gregori, Baris Ilerigelen, Ricarda Marinigh, Paolo M. Fioretti

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

This study compared the cost-effectiveness of dobutamine-atropine stress echocardiography (DASE) and electrocardiographic exercise testing (EET) implemented in emergency department accelerated diagnostic protocols for the early stratification of low-risk patients presenting with acute chest pain (ACP). One hundred ninety-nine patients with ACP, nondiagnostic electrocardiographic results, and negative biomarker results were randomized to DASE (n = 110) or EET (n = 89) <6 hours after emergency department presentation. Patients with negative risk assessment results were immediately discharged and followed for 2 months. Ninety patients (82%) in the DASE arm and 78 (88%) in the EET arm were discharged after the diagnosis of nonischemic ACP. The mean lengths of stay in the hospital were 23 ± 12 and 31 ± 23 hours in the DASE and EET arms, respectively (p = 0.01). No 2-month follow-up events occurred in DASE patients, and the event rate was significantly higher in EET patients (0% vs 11%, p = 0.004). The DASE strategy showed lower costs compared with the EET strategy at 1-month ($1,026 ± $250 vs $1,329 ± $1,288, p = 0.03) and 2-month ($1,029 ± 253 vs $1,684 ± $2,149, p = 0.005) follow-up. In conclusion, early DASE in emergency department triage of low-risk patients with ACP is safe and reduces costs of care compared to EET.

LanguageEnglish
Pages1068-1073
Number of pages6
JournalAmerican Journal of Cardiology
Volume100
Issue number7
DOIs
Publication statusPublished - 1 Oct 2007

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nucifora, Gaetano ; Badano, Luigi P. ; Sarraf-Zadegan, Nizal ; Karavidas, Apostolos ; Trocino, Giuseppe ; Scaffidi, Giorgio ; Pettinati, Gianni ; Astarita, Costantino ; Vysniauskas, Vitas ; Gregori, Dario ; Ilerigelen, Baris ; Marinigh, Ricarda ; Fioretti, Paolo M. / Comparison of Early Dobutamine Stress Echocardiography and Exercise Electrocardiographic Testing for Management of Patients Presenting to the Emergency Department With Chest Pain. In: American Journal of Cardiology. 2007 ; Vol. 100, No. 7. pp. 1068-1073.
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abstract = "This study compared the cost-effectiveness of dobutamine-atropine stress echocardiography (DASE) and electrocardiographic exercise testing (EET) implemented in emergency department accelerated diagnostic protocols for the early stratification of low-risk patients presenting with acute chest pain (ACP). One hundred ninety-nine patients with ACP, nondiagnostic electrocardiographic results, and negative biomarker results were randomized to DASE (n = 110) or EET (n = 89) <6 hours after emergency department presentation. Patients with negative risk assessment results were immediately discharged and followed for 2 months. Ninety patients (82{\%}) in the DASE arm and 78 (88{\%}) in the EET arm were discharged after the diagnosis of nonischemic ACP. The mean lengths of stay in the hospital were 23 ± 12 and 31 ± 23 hours in the DASE and EET arms, respectively (p = 0.01). No 2-month follow-up events occurred in DASE patients, and the event rate was significantly higher in EET patients (0{\%} vs 11{\%}, p = 0.004). The DASE strategy showed lower costs compared with the EET strategy at 1-month ($1,026 ± $250 vs $1,329 ± $1,288, p = 0.03) and 2-month ($1,029 ± 253 vs $1,684 ± $2,149, p = 0.005) follow-up. In conclusion, early DASE in emergency department triage of low-risk patients with ACP is safe and reduces costs of care compared to EET.",
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Nucifora, G, Badano, LP, Sarraf-Zadegan, N, Karavidas, A, Trocino, G, Scaffidi, G, Pettinati, G, Astarita, C, Vysniauskas, V, Gregori, D, Ilerigelen, B, Marinigh, R & Fioretti, PM 2007, 'Comparison of Early Dobutamine Stress Echocardiography and Exercise Electrocardiographic Testing for Management of Patients Presenting to the Emergency Department With Chest Pain', American Journal of Cardiology, vol. 100, no. 7, pp. 1068-1073. https://doi.org/10.1016/j.amjcard.2007.05.027

Comparison of Early Dobutamine Stress Echocardiography and Exercise Electrocardiographic Testing for Management of Patients Presenting to the Emergency Department With Chest Pain. / Nucifora, Gaetano; Badano, Luigi P.; Sarraf-Zadegan, Nizal; Karavidas, Apostolos; Trocino, Giuseppe; Scaffidi, Giorgio; Pettinati, Gianni; Astarita, Costantino; Vysniauskas, Vitas; Gregori, Dario; Ilerigelen, Baris; Marinigh, Ricarda; Fioretti, Paolo M.

In: American Journal of Cardiology, Vol. 100, No. 7, 01.10.2007, p. 1068-1073.

Research output: Contribution to journalArticle

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T1 - Comparison of Early Dobutamine Stress Echocardiography and Exercise Electrocardiographic Testing for Management of Patients Presenting to the Emergency Department With Chest Pain

AU - Nucifora, Gaetano

AU - Badano, Luigi P.

AU - Sarraf-Zadegan, Nizal

AU - Karavidas, Apostolos

AU - Trocino, Giuseppe

AU - Scaffidi, Giorgio

AU - Pettinati, Gianni

AU - Astarita, Costantino

AU - Vysniauskas, Vitas

AU - Gregori, Dario

AU - Ilerigelen, Baris

AU - Marinigh, Ricarda

AU - Fioretti, Paolo M.

PY - 2007/10/1

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N2 - This study compared the cost-effectiveness of dobutamine-atropine stress echocardiography (DASE) and electrocardiographic exercise testing (EET) implemented in emergency department accelerated diagnostic protocols for the early stratification of low-risk patients presenting with acute chest pain (ACP). One hundred ninety-nine patients with ACP, nondiagnostic electrocardiographic results, and negative biomarker results were randomized to DASE (n = 110) or EET (n = 89) <6 hours after emergency department presentation. Patients with negative risk assessment results were immediately discharged and followed for 2 months. Ninety patients (82%) in the DASE arm and 78 (88%) in the EET arm were discharged after the diagnosis of nonischemic ACP. The mean lengths of stay in the hospital were 23 ± 12 and 31 ± 23 hours in the DASE and EET arms, respectively (p = 0.01). No 2-month follow-up events occurred in DASE patients, and the event rate was significantly higher in EET patients (0% vs 11%, p = 0.004). The DASE strategy showed lower costs compared with the EET strategy at 1-month ($1,026 ± $250 vs $1,329 ± $1,288, p = 0.03) and 2-month ($1,029 ± 253 vs $1,684 ± $2,149, p = 0.005) follow-up. In conclusion, early DASE in emergency department triage of low-risk patients with ACP is safe and reduces costs of care compared to EET.

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