Box 1 Selection criteria for immediate exercise test

Chest pain suspicious for myocardial ischemia Able to exercise

ECG normal, minor ST-T changes, or no change from previous abnormal ECG Hemodynamically stable, no arrhythmia A single negative serum marker is measured in selected patients demonstrated CAD in 57% of those with a positive test and 30-day follow-up revealed no mortality or morbidity in the negative or nondiagnostic groups. This study demonstrated the safety of proceeding to exercise testing in carefully selected patients on the basis of the initial presentation without serial ECGs or cardiac injury markers. However, its limited numbers required a larger patient population for confirmation of the feasibility of this strategy.

In the largest single center study of exercise testing in low-risk patients, the authors reported results in 1000 patients (see Table 1) [45]. This study incorporated their current approach, which includes confirmation of a single negative cardiac

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