Professional guidelines recommend non-invasive cardiac testing (NIT) within 72 hours of an emergency department (ED) evaluation for suspected acute coronary syndrome. However, a study published in JAMA Internal Medicine reveals that NIT should be reserved for patients at substantial risk of poor outcomes.
The retrospective analysis included 79,040 patients, comparing the effectiveness of NIT versus no testing in patients with chest pain and in whom acute myocardial infarction (MI) was ruled out when presenting to the ED. The primary outcome was the composite risk of death or acute MI, within 30 days of an ED discharge.
Early NIT was associated with a small (0.4%) but significant decrease in the absolute composite risk of death or MI. The number needed to treat was 250 to avoid one death or MI, 500 to avoid one death, 333 to avoid one MI, and 200 to avoid one major adverse cardiovascular event within 30 days.
Based on these findings, the authors question if early NIT is a suitable clinical strategy for most patients. They support selective use of NIT, avoiding such testing for most patients evaluated in the ED and reserving it for patients at substantial risk of 30-day adverse cardiovascular outcomes.