During the nearly month-long follow-up period, there were no differences between the two groups in the percentages of patients that had a stent placed to open an artery, underwent coronary artery bypass surgery, returned to the emergency room or experienced a major cardiac event, such as heart attack.

While providing no clear health benefit to emergency room patients, the extra tests also led patients to stay in the hospital longer than may have been necessary and exposed them to radiation from testing that was not required to diagnose a heart attack. Length-of-stay for patients who received less testing was, on average, 20 hours compared with 28 hours for those who did receive either of the two additional tests.


The analysis also showed that, on average, a patient receiving more testing accrued $500 more in health-care costs during the ER visit. Patients who received more testing during the initial ER visit also received more follow-up tests, leading to $300 more in health-care costs for this group during the 28-day follow-up period. With 10 million patients coming to the ER for chest pain each year in the United States, these extra costs add up, according to the investigators.

"It's important to keep in mind that CT scans and stress tests are used to diagnose coronary disease -- whether someone has plaque in the arteries," Brown said. "Many people have coronary plaque but are not having a heart attack.

"The goal of evaluating patients with chest pain in the ER is not to screen for coronary artery disease," he said. "Anyone who goes to the ER for chest pain and gets sent home should make an appointment to see their primary care doctor to talk about their recent hospital visit. It's important to follow up to see if additional testing is warranted because screening tests are not appropriate in this specific emergency situation."

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