Related Experiment Video
Updated: Mar 17, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Diagnostic Yield of Routine Stress Testing in Low and Intermediate Risk Chest Pain Patients Under 40 Years: A
1From the Griffith University, Queensland, Australia.
Insights
Routine stress testing for chest pain in patients under 40 yields few cardiac diagnoses. This systematic review found a low diagnostic yield, suggesting it may not be beneficial for this low-risk group.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Evidence-Based Medicine
Background:
- Chest pain is a common emergency department presentation.
- Most patients undergo diagnostic workup for acute coronary syndrome, but cardiac causes are rare.
- Patients under 40 are considered lower risk, questioning the utility of routine stress testing.
Purpose of the Study:
- To systematically review the diagnostic yield of routine stress testing.
- To evaluate its benefit in low- and intermediate-risk chest pain patients under 40 years.
Main Methods:
- Systematic review of electronic databases.
- Quality assessment using NHMRC evidence hierarchy and McMaster Critical Appraisal Tool.
- Descriptive statistics to summarize findings.
Main Results:
- Five primary studies (Level III-3 evidence) and 7 additional data sources were included.
- Diagnostic yield ranged from 0% to 1.1% in low- and intermediate-risk patients under 40.
- Combined data showed 0.24% true positive stress tests in primary studies and 0.32% in additional sources.
Conclusions:
- Routine stress testing in younger, lower-risk chest pain patients has a low diagnostic yield.
- Higher quality studies are needed to confirm these findings and guide clinical practice.
Objective:
Chest pain is one of the most frequent causes for presentation to emergency departments (EDs). The majority of patients will undergo diagnostic workup including stress testing to rule out an acute coronary syndrome, but very few patients will be diagnosed with a cardiac cause for their pain. Patients under 40 years represent a lower risk group in which routine stress testing may be of little benefit. This systematic review sought to determine the diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years.
Methods:
Electronic databases were searched for relevant studies. The quality of the included primary studies was assessed using the National Health and Medical Research Council evidence hierarchy and the McMaster Critical Appraisal Tool for Quantitative Studies. Descriptive statistics summarized the findings.
Results:
Five primary studies were included in the review (all level III-3 evidence); 7 additional sources of relevant data were also included. Diagnostic yield of routine stress testing in low- and intermediate-risk patients under 40 years is reported between 0% and 1.1%. Combined data from included primary studies demonstrated just 4 out of 1683 true positive stress tests (0.24%), only one of which was definitively confirmed by coronary angiogram; additional data sources identified just 1 out of 310 true positive stress tests (0.32%).
Conclusions:
Diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years is low. However, better quality studies are required to be able to draw definitive conclusions.
