Use of invasive and nuclear stress testing in patients with acute ischemic coronary syndromes in a large, urban, university-affiliate hospital

Background Several recent studies have suggested a high use of invasive procedures after acute myocardial infarction, without a corresponding improvement in survival. We assessed the relative use of invasive procedures and nuclear cardiac testing during acute coronary syndromes. Methods and Results. We examined the in-hospital utilization rates of invasive and nuclear stress tests and their association with in-hospital mortality in all patients hospitalized with an acute coronary syndrome in a single, university-affiliate hospital for 3 years. The study cohort consisted of 1704 consecutive patients with acute myocardial infarction and 2414 patients with unstable angina pectoris, The utilization rate of nuclear stress testing was much lower than that of coronary angiography in patients with either acute myocardial infarction (11.9% vs 73.9%, P < .001) or unstable angina (8.5% vs. 79.3%, P < .001), Patients examined with nuclear stress testing, as compared with patients examined solely by means of coronary angiography, had lower revascularization and in-hospital mortality rates, both after acute myocardial infarction (29.2% vs 70%, P < .001, and 1.5% vs 9.6%, P < .001, respectively) and unstable angina (14.6% vs 80.6%, P < .001, and 1% vs 5.1%, P < .001, respectively), Revascularization guided by means of nuclear stress testing had a lower mortality rate than that performed without the benefit of a nuclear test, both in patients with acute myocardial infarction (0% vs 10.5%) and in patients with unstable angina (0% vs 5.9%). Conclusion. Noninvasive stress imaging was used much less often than coronary angiography in patients with acute coronary syndromes, The lower mortality rate of patients examined with nuclear stress testing, compared with patients examined solely by means of coronary angiography, deserves further study, especially in patients undergoing revascularization.