OBJECTIVE To evaluate the use of stress testing in a community population with de novo stable chest pain, a normal resting electrocardiogram (ECG), and the ability to exercise. PATIENTS AND METHODS We identified eligible patients by searching the electronic medical record of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013. We determined the frequency of initial exercise stress testing, computed tomography coronary angiography, and invasive coronary angiography, as well as the use of subsequent second procedures (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting) within 90 days. Patients were followed for 5 years for death, nonfatal myocardial infarction, and hospitalization for unstable angina. RESULTS The data search identified 1175 patients with chest pain and normal resting ECGs. Only 331 patients underwent cardiac testing. A slight majority (185; 55.9%) underwent an exercise ECG alone. The remainder underwent exercise echocardiography (112; 33.8%), exercise single-photon-emission computed tomography (32; 9.7%), or computed tomography coronary angiography (2; 0.9%). Few patients (30; 9.1%) required additional testing within 90 days. Of the 14 patients (4.2%) who underwent invasive coronary angiography, 12 (85.7%) had significant coronary artery disease, and were referred for percutaneous coronary intervention or coronary artery bypass grafting. At 5 years, the mortality rate was 1.2%, and the combined event rate was 3.8%. CONCLUSION Most community patients with chest pain and a normal resting ECG do not require further cardiac evaluation. In patients who require testing, and are able to exercise, noninvasive stress testing is preferred. Invasive coronary angiography is applied selectively and associated with a high rate of significant coronary artery disease and referral to coronary revascularization. Long-term outcomes are excellent.

中文翻译：

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评估社区稳定胸痛中的压力测试。

目的评估压力测试在具有从头稳定胸痛，正常静息心电图（ECG）和运动能力的社区人群中的使用。病人和方法我们通过检索从2010年1月1日至2013年12月31日在罗切斯特梅奥诊所就诊的所有门诊病人的电子病历，对符合条件的患者进行了搜索。在90天内进行冠状动脉造影以及随后的第二次手术（包括经皮冠状动脉介入治疗[PCI]和冠状动脉搭桥术）。对患者进行了为期5年的死亡，非致命性心肌梗塞和不稳定型心绞痛住院治疗的随访。结果数据搜索确定了1175例胸痛和静息心电图正常的患者。只有331例患者接受了心脏检查。极少数（185; 55.9％）仅接受运动心电图检查。其余患者进行了运动超声心动图检查（112； 33.8％），运动单光子发射计算机断层扫描（32； 9.7％）或计算机断层扫描冠状动脉造影（2； 0.9％）。很少有患者（30; 9.1％）需要在90天内进行额外测试。在接受侵入性冠状动脉造影术的14例患者（4.2％）中，有12例（85.7％）患有严重的冠状动脉疾病，并接受了经皮冠状动脉介入治疗或冠状动脉搭桥术。在5年时，死亡率为1.2％，综合事件发生率为3.8％。结论大多数胸痛且心电图正常的社区患者不需要进一步的心脏评估。在需要测试并能够运动的患者中，首选非侵入性压力测试。选择性应用有创冠状动脉造影术，并与高比率的重大冠状动脉疾病和转诊至冠状动脉血运重建相关。长期结果是极好的。