Early Noninvasive Cardiac Testing Reduces Mortality Risk
Early noninvasive cardiac testing (NIT) for patients who presented to the emergency department (ED) with suspected acute coronary syndrome has been linked to a small decrease in both death risk and acute myocardial infarction (MI), according to the results of a recent study.
The researchers conducted a retrospective, multicenter cohort study using data from the Kaiser Permanente Southern California integrated health care delivery system. The 79,040 total patients had presented to the ED with chest pain between January 2015 and December 2017.
The researchers compared the results in patients who had NIT within the recommended 72-hour period after ED presentation (n = 16164), and those who had no testing and were ruled out for acute MI. All patients were followed up for 30 days after their ED discharge.
The results indicated that early NIT was associated with a small decrease of 0.4% in the absolute composite risk of death or MI (95% CI, (-0.6) – (- 0.3)). There was a 0.2% decrease in death (95% CI, (-0.2)-(0.1)) and a 0.3% decrease in MI (95% CI, (-0.5)-(0.1)), as well as a 0.5% decrease for other major adverse cardiac events (95% CI, (-0.7)-(0.3)). In order to avoid 1 death or MI, 250 patients needed to be treated. Secondary outcomes showed that the number changed to 14 needed to be treated to avoid 1 death or MI in patients with elevated troponin.
“Early NIT was associated with a small decrease in the risk of death or MI in patients admitted to the ED with suspected acute coronary syndrome, but this clinical strategy may not be optimal for most patients given the large number needed to treat,” the researchers concluded.
Kawatkar AA, Sharp AL, Baecker AS, et al. Early noninvasive cardiac testing after emergency department evaluation for suspected acute coronary syndrome. JAMA Intern Med. Published online October 5, 2020. Doi: 10.1001/jamainternmed.2020.4325