Exercise testing in chest pain units: Rationale, implementation, and results

CPUs are now established centers for assessment of low-risk patients presenting to the ED with symptoms suggestive of ACS. ADPs, of which treadmill testing is a key component, have been developed within these units for efficient evaluation of these patients. Studies of the last decade have established the utility of early exercise testing, which has been safe, accurate, and cost-effective in this setting. Specific diagnostic protocols vary, but most require 6 to12 hours of observation by serial ECGs and cardiac injury markers to exclude infarction and high-risk unstable angina before proceeding to exercise testing. However, in the CPU at UC Davis Medical Center, the approach includes 'immediate' treadmill testing without a traditional process to rule out MI. Extensive experience has validated this approach in a large, heterogeneous population. The optimal strategy for evaluating low-risk patients presenting to the ED with chest pain will continue to evolve based on current research and the development of new methods.