chest pain with recent negative stress test

EP MONTHLY EXCERPT:
--nice overview on stress tests from March 2011(see reference link)


DOES THE RECENT NEGATIVE STRESS MEAN THIS PATIENT CAN'T HAVE ACS?
--No.
--stress tests are good, not great


SOME ROUGH EXAMPLES:
--Sensitivity for single vessel CAD:

• exercise ECG stress test ~68%
• exercise nuclear stress test (thallium) 60-82%
• exercise nuclear stress test (sestamibi) 82-97%
• adenosine/dipyridamole nuclear stress 77-92%
• dobutamine nuclear stress 80-100%

BOTTOM LINE:
--stress sensitivity is not perfect
--negative stress test does NOT rule out ACS


Reference(s): ep monthly article, picture