Noninvasive Cardiac Testing and Cardiovascular Outcomes for Low-Risk Chest Pain in the Emergency Department: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: With the widespread adoption of high-sensitivity troponin testing, recent guidelines no longer recommend urgent noninvasive cardiac testing for suspected cardiac disease in low-risk emergency department (ED) patients. We conducted a meta-analysis to determine whether urgent noninvasive testing, compared to no testing, is associated with improved cardiovascular outcomes in low-risk patients. Methods: We searched databases for studies of adults evaluated in the ED for low-risk acute chest pain based on clinical criteria, diagnostic testing, or risk scores. Outcomes were all-cause death or myocardial infarction (MI), and revascularization alone, at 90 days and 1 year. Results: A total of 1.5 million patients were included from 17 observational and 2 randomized studies. The overall rate of death or MI was 0.3% at 90 days, and 0.4% at 1 year. The odds of death or MI were not significantly different at 90 days (9 studies with 144,447 participants; odds ratio [OR] = 0.92 [0.48-1.76]) or 1 year (13 studies with 146,563 participants; OR = 0.92 [0.63-1.35]) between the tested and nontested groups. The odds of revascularization were significantly higher in tested groups at 90 days (12 studies with 513,862 participants; OR = 2.21 [1.17-4.17]) and 1 year (16 studies with 1,441,693 participants; OR = 2.61 [1.95-3.48]). Conclusions: Noninvasive testing for low-risk chest pain in the ED was not associated with lower odds of death or MI, but it was associated with more than twice the odds of revascularization. This finding supports current guidelines recommending against universal noninvasive testing for ED patients with low-risk chest pain.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.016 | 0.006 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".