Inpatient Stress Test Modality and Downstream Clinical Pathways in Troponin-Negative Patients: A Real-World Cohort
Admire Hlupeni1,2, Sudden Turugari3, Jeffrey Murray4
1Immunology, Midlands State University, Gweru, ZWE.
Cureus
|June 8, 2026
Summary
For troponin-negative patients with suspected acute coronary syndrome, inpatient stress testing using nuclear myocardial perfusion imaging (MPI) or stress echocardiography showed similar diagnostic yield and downstream referral rates for invasive coronary angiography (ICA). The choice of stress test modality had minimal impact on clinical decisions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Decision-Making
Background:
- Troponin-negative patients with suspected acute coronary syndrome often undergo inpatient stress testing.
- The comparative effectiveness of different stress test modalities in this population is not well-established.
- Understanding modality yield is crucial for guiding clinical decisions and resource allocation.
Purpose of the Study:
- To compare the diagnostic yield and downstream clinical outcomes of different inpatient stress test modalities.
- To evaluate the association between stress test modality and referral for invasive coronary angiography (ICA).
- To assess the influence of stress test modality on the detection of obstructive coronary artery disease (CAD).
Main Methods:
- Retrospective cohort study of 769 troponin-negative adult patients undergoing inpatient stress testing.
- Modalities included nuclear myocardial perfusion imaging (MPI), stress echocardiography, and exercise electrocardiography (ECG)-only.
- Outcomes: stress test positivity, referral to ICA, obstructive CAD detection, and revascularization. Multivariable Poisson regression was used for analysis.
Main Results:
- Nuclear MPI and stress echocardiography demonstrated similar stress test positivity rates (9.7% vs 8.3%).
- Referral to ICA, obstructive CAD detection, and revascularization rates were comparable between MPI and stress echocardiography groups.
- Stress test modality was not independently associated with stress test positivity or ICA referral after adjustment.
Conclusions:
- In this single-center study, nuclear MPI and stress echocardiography showed similar diagnostic yield and downstream management in troponin-negative patients.
- Stress test modality appears to have limited influence on clinical decision-making in this patient group.
- Findings suggest that modality choice may be less critical than test interpretation for guiding subsequent care.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
01:26Exercise Stress Test
Introduction
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
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
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:20Angina V: Nursing Management
Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...