Exercise echocardiography and risk of all-cause mortality in patients referred to a chest pain unit for acute chest pain, nondiagnostic electrocardiograms and negative troponin levels

Purpose: To determine the predictors of all-cause mortality in patients with acute chest pain and negative troponin undergoing exercise echocardiography. Methods: A total of 1646 patients were referred to our chest pain unit for acute chest pain, nondiagnostic resting electrocardiograms and negative troponin I levels, and underwent exercise echocardiography within 24 hours of the chest pain episode. An abnormal exercise echocardiogram was defined as a peak wall motion score index (pWMSI) >1. The endpoint was all-cause mortality. Results: Mean age was 63.2±12.3 years, and 1068 patients were male. During an average follow-up of 2.35±1.50 years, 55 patients died. The 5-year mortality rate was 4.1% in patients with a normal exercise echocardiogram vs. 13.1% in those with abnormal results (p <0.001). In Cox regression analysis, male gender (HR 2.25, 95% CI 1.13-4.48), age (HR 1.06, 95% CI 1.03-1.09), exercise workload in METs (HR 0.85, 95% CI 0.76-0.95) and pWMSI (HR 2.67, 95% CI 1.38-5.14) remained predictors of all-cause mortality. ![Figure][1] Figure 1. Mortality curves according to pWMSI Conclusions: Exercise echocardiography provides significant prognostic information for the prediction of all-cause mortality in patients with acute chest pain, nondiagnostic resting electrocardiograms and negative troponin results. [1]: pending:yes