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Applying the Diamond Criteria Could Improve Utilization of Stress Echocardiography for Patients Who Present to the Emergency Department With Low-risk Chest Pain

Foy, Andrew MD; Baquero, Giselle A. MD; Naccarelli, Gerald V. MD; Kozak, Mark MD

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine: June 2014 - Volume 13 - Issue 2 - p 49–54
doi: 10.1097/HPC.0000000000000010
Original Articles

We identified all patients with age 21 years and older, without a history of obstructive coronary artery disease, who presented to the emergency department with chest pain, and were admitted for cardiac observation followed by stress echocardiography during a 1-year period. The positive predictive value of stress echocardiography and cardiovascular outcomes were compared based on patients’ Diamond chest pain classification. In patients with typical chest pain, who accounted for 8.7% (44/503) of the total cohort, the positive predictive value of stress echocardiography was 75% compared with 0% for all other subgroups (P = 0.007). Six patients (14%) with typical chest pain went on to have coronary revascularization compared with 0% for all other subgroups (P < 0.001). No patient in any subgroup died or was readmitted with a myocardial infarction in 30 days. Applying the Diamond criteria could improve utilization of stress echocardiography for patients with low-risk chest pain in the emergency department.

From the Division of Cardiology, Penn State M.S. Hershey Medical Center, Hershey, PA.

Reprints: Andrew Foy, MD, Penn State M.S. Hershey Medical Center, Division of Cardiology, 717-531-5888, 500 University Drive, PO Box 850 H047, Hershey, PA 17033-0850. E-mail: afoy@hmc.psu.edu.

© 2014 by Lippincott Williams & Wilkins