Related Experiment Video
Updated: Mar 8, 2026
Author Spotlight: Exercise Test for Evaluation of the Functional Efficacy of the Pig Cardiovascular System
Published on: May 12, 2023
Comparative efficiency of exercise stress testing with and without stress-only myocardial perfusion imaging in
Jossef Amirian1,2, Omid Javdan3, Jason Misher4
1Division of Cardiovascular Diseases, Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart at Mount Sinai Beth Israel, First Avenue at 17th Street, 5 Baird Hall, New York, NY, 10003, USA. jamirian@chpnet.org.
Insights
For low-risk chest pain patients, exercise treadmill testing (ETT) and stress-only myocardial perfusion imaging (sMPI) showed similar major adverse cardiac event (MACE) rates. sMPI reduced repeat testing but increased costs and length of stay.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Clinical decision units (CDUs) aim to improve efficiency and resource utilization in healthcare.
- The optimal diagnostic strategy for low-risk chest pain patients in CDUs to balance outcomes and costs remains undefined.
Purpose of the Study:
- To compare major adverse cardiac event (MACE) rates, resource utilization, and direct costs for low-risk chest pain patients managed with exercise treadmill testing (ETT) versus stress-only myocardial perfusion imaging (sMPI) in a CDU.
Main Methods:
- A propensity score-matched (PSM) analysis of 680 patients (340 pairs) from two locations was conducted.
- Outcomes assessed included length of stay >24 hours, MACE (acute coronary syndrome, revascularization, cardiac death), downstream resource use, and mean direct cost per patient.
Main Results:
- The majority of tests (98%) were normal, with low MACE rates (1% at 1 year).
- The sMPI group experienced longer stays (>24 hours) and higher mean direct costs (30% more) compared to the ETT group.
- While sMPI led to less repeat testing, the overall cost and length of stay were greater.
Conclusions:
- For low-risk chest pain patients in CDUs, both ETT and sMPI yield low MACE rates.
- sMPI reduces downstream testing but is associated with increased healthcare expenses and longer observation periods compared to ETT.
Objectives:
To compare major adverse cardiac event (MACE), downstream resource utilization, and direct cost of care for low-risk chest pain patients observed in the clinical decision unit (CDU) with exercise treadmill testing (ETT) and with stress-only myocardial perfusion imaging (sMPI).
Background:
CDUs are poised to increase efficiency and resource utilization. However, the optimal testing strategy that would assure favorable outcomes while decreasing cost is not defined.
Methods:
1016 subjects from 2 locations were propensity score-matched (PSM) by age, gender, pre-test likelihood, Duke treadmill score, and test results. Outcomes were length of stay >24 hours, MACE (acute coronary syndrome, revascularization, cardiac death), downstream resource use (admission for chest pain, repeat testing, angiography), and mean direct cost per patient.
Results:
PSM yielded 680 patients (340 matches). 98% of all tests were normal. 96.6% of patients were discharged from the CDU within 24 hours but twice as many exceeded 24 hours in the sMPI group. There were no cardiac deaths. MACE rate was 1.47% at 72 hours and 1% at 1 year. Downstream resource use was 4.82% at 72 hours, and 7.69% at 1 year. The sMPI group was event-free longer than the ETT group reflecting less repeat testing. The mean direct cost was 30% higher for sMPI ($3168.70) vs. ETT ($2226.96).
Conclusion:
Low-risk chest pain patients in the observation unit had low MACE rate, not different for ETT vs. sMPI. The majority of ETT and sMPI tests were normal. The sMPI reduced additional testing, but resulted in greater expense and longer stay.
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:28Imaging Studies for Cardiovascular System V: CT
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:29Angina III: Clinical Manifestations and Assessment