The excellent article by Safavi et al and commentary by Amsterdam and Aman remind us that the first question in evaluation of patients with chest pain who are at low risk for myocardial infarction is not “What test should I order?” but rather “Does this patient need any further testing?” Many patients can be safely discharged from the emergency department to outpatient follow-up without any stress test or imaging such as cardiac computed tomography. Certainly, no one wants to miss a myocardial infarction, but we also do not want to keep people for hours and days to perform additional imaging tests that are not associated with better outcomes but may lead to increased radiation exposure. More time spent talking with patients about their symptoms and their functional status, as well as the risks and benefits of immediate vs deferred testing, is likely to result in shorter emergency department stays and fewer unnecessary tests.
Redberg RF. Priorities in the Evaluation of Patients With Chest Pain. JAMA Intern Med. 2014;174(4):554. doi:10.1001/jamainternmed.2013.14381