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Invited Commentary |

How Provocative Is Provocative Testing?  Comment on “Yield of Routine Provocative Cardiac Testing Among Patients in an Emergency Department–Based Chest Pain Unit

Lee Goldman, MD
JAMA Intern Med. 2013;173(12):1134-1135. doi:10.1001/jamainternmed.2013.6812.
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In this issue of JAMA Internal Medicine, Hermann et al1 report on a large cohort of patients who underwent routine provocative testing before discharge from a chest pain unit. The criteria for admission to the chest pain unit were based on a clinical suspicion of acute myocardial ischemia in the absence of ischemic electrocardiographic changes, pain that was the same as a prior myocardial infarction (MI), or the worsening of previous stable angina.2 Although their study does not tell us how many of their patients subsequently developed an acute MI or an acute coronary syndrome (ACS), either while under observation in the chest pain unit or during the follow-up assessment, their patients undoubtedly had a low probability of acute MI or ACS.

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