(VP126) UTILITY OF DOWNSTREAM STRESS TEST IMAGING FOR RISK STRATIFICATION OF PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH CHEST PAIN AND LOW HEART SCORE.

Background: HEART score is widely used for risk stratification of chest pain in the emergency department (ED). Current guidelines recommend discharging patients with low-risk heart score (LRHS) as the expected future cardiac events are low. However, there is controversy in the management plan with the increasing evidence of non-negligible cardiac events among LRHS patients. In this study we aim to investigate the value of downstream non-invasive stress imaging test (NISI) in predicting cardiac events in patients with LRHS.

METHODS AND RESULTS: We prospectively included 1384 patients with LRHS between 2019 to 2021. All patients underwent NISI (myocardial perfusion imaging or stress echocardiography). Primary endpoints were: Cardiac deaths, nonfatal myocardial infarctions, and significant coronary stenosis. Secondary endpoints define as cardiovascular-related admission or ED visit.

The mean age was 64±14 years, 670 (48.4%) were women. During the follow-up period of 634±104 days, 58/1384 (4.2%) patients developed 62 primary endpoints and 60 (4.3%) patients developed secondary endpoints. Multivariable cox models adjusted to clinical and imaging variables which showed that diabetes (Hazard ratio (HR): 2.38; 95% CI: 1.25-4.49, P=0.008), HEART score of 3 (HR: 1.32; 95% CI 0.83- 1.89; P=0.01 ), prior history of CAD had HR of 2.75 (95% CI: 1.40-5.41; P=0.003), ECG changes (HR: 5.11; 95% CI: 2.61-10.01; P< 0.0001), and abnormal NISI (HR:16.4; 95% CI: 9.56-28.03; P< 0.0001) in predicting primary endpoints, In contrast, abnormal NISI was the sole predictor of secondary endpoints with (HR:3.05; 95% CI: 1.31-7.14; P< 0.0001).

Conclusion: NISI significantly predict primary cardiac events and cardiovascular-related readmission/ED visits in patients with LRHS.